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General NPI Number Information
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NPI Number | 1386471084
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Entity Type | Organization
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Legal Business Name | ADOLESCENT WELLNESS ACADEMY LLC
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 4900 S UNIVERSITY DR STE 204
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City | DAVIE
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State | FL
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Zip | 33328-3811
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Country | US
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Telephone | 561-816-9023
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Fax | 954-368-1345
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Provider Business Mailing Address
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Address Line | 4900 S UNIVERSITY DR STE 204
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City | DAVIE
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State | FL
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Zip | 33328-3811
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Country | US
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Telephone | 561-816-9023
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Fax | 954-368-1345
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Authorized Official
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Title or Position | CEO
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Name | DUSTIN JOHNSON
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Credential |
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Telephone | 561-816-9023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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