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General NPI Number Information
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NPI Number | 1437739976
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Entity Type | Organization
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Legal Business Name | DAHLIA WELLNESS LLC
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 5290 DON MANUEL RD
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City | ELKTON
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State | FL
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Zip | 32033-3220
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Country | US
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Telephone | 190-539-2918
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Fax |
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Provider Business Mailing Address
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Address Line | 5290 DON MANUEL RD
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City | ELKTON
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State | FL
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Zip | 32033-3220
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Country | US
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Telephone | 43-929-1889
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KASSANDRA SHUGARS MCCUNE
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Credential | LMHC
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Telephone | 904-392-9188
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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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