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General NPI Number Information
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NPI Number | 1063675213
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Entity Type | Organization
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Legal Business Name | HEALING CIRCLE FOR CHILDREN AND FAMILIES
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 14869 S DIXIE HWY
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City | PALMETTO BAY
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State | FL
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Zip | 33176-7928
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Country | US
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Telephone | 305-969-7102
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Fax |
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Provider Business Mailing Address
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Address Line | 9351 SW 165TH ST
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City | PALMETTO BAY
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State | FL
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Zip | 33157-3448
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Country | US
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Telephone | 305-298-6561
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | LORA COLEMAN-HERNANDEZ
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Credential | LCSW
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Telephone | 305-298-6561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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