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General NPI Number Information
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NPI Number | 1295244127
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Entity Type | Organization
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Legal Business Name | WILLOW HARBOR THERAPY CENTER, LLC
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Dates
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Enumeration Date | 09/22/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1010 N 12TH AVE STE 321
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City | PENSACOLA
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State | FL
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Zip | 32501-3370
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Country | US
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Telephone | 850-776-6297
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 N 12TH AVE STE 321
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City | PENSACOLA
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State | FL
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Zip | 32501-3370
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Country | US
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Telephone | 850-776-6297
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. SABRINA IRENE CONKLIN
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Credential | DSW, LCSW
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Telephone | 850-776-6297
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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 | SW12317
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License Number State | FL
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