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General NPI Number Information
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NPI Number | 1396214102
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Entity Type | Organization
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Legal Business Name | EPIC WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 11/21/2018
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Last Update Date | 09/22/2019
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Provider Practice Location Address
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Address Line | 465 W 41ST ST PH
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City | MIAMI BEACH
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State | FL
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Zip | 33140-3503
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Country | US
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Telephone | 786-708-7166
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Fax |
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Provider Business Mailing Address
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Address Line | 309 S 57TH TER
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City | HOLLYWOOD
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State | FL
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Zip | 33023-1426
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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 | CEO
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Name | NICOLE BERRY
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Credential |
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Telephone | 305-338-4027
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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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