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General NPI Number Information
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NPI Number | 1356146625
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Entity Type | Organization
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Legal Business Name | SELF-LOVE HARBOR
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 17800 W DIXIE HWY STE C3
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City | N MIAMI BEACH
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State | FL
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Zip | 33160-5691
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Country | US
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Telephone | 786-475-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 NE 123RD ST
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2804
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STELLA VIDAL
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Credential |
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Telephone | 786-475-1119
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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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