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General NPI Number Information
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NPI Number | 1437550266
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Entity Type | Organization
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Legal Business Name | HEALING EDUCATIONAL ALTERNATIVES FOR DESERVING STUDENTS
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 50 N LAURA ST SUITE 2500
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3664
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Country | US
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Telephone | 813-754-5555
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Fax | 813-754-5552
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Provider Business Mailing Address
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Address Line | 1001 E BAKER ST SUITE 202
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City | PLANT CITY
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State | FL
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Zip | 33563-3700
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Country | US
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Telephone | 813-754-5555
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Fax | 813-754-5552
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Authorized Official
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Title or Position | COO
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Name | EDWARD A WALLER
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Credential | M.ED
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Telephone | 813-754-5555
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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 | 05
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License Number State | FL
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