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General NPI Number Information
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NPI Number | 1154988772
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Entity Type | Organization
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Legal Business Name | THE HEALING IMPACT, INC
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 4 9TH AVE STE F
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City | SHALIMAR
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State | FL
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Zip | 32579-1742
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Country | US
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Telephone | 850-420-9317
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Fax | 850-505-3078
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Provider Business Mailing Address
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Address Line | 5170 ANNIE RUTH ST
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City | MILTON
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State | FL
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Zip | 32570-8153
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Country | US
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Telephone | 850-420-9317
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Fax | 850-505-3078
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Authorized Official
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Title or Position | CEO
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Name | MRS. AMY ELLIS
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Credential | LMHC
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Telephone | 850-261-9032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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