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General NPI Number Information
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NPI Number | 1437885720
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Entity Type | Organization
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Legal Business Name | THE MENDING ROOM COUNSELING CENTER FOR WELLNESS
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 4300 N UNIVERSITY DR # A153
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City | LAUDERHILL
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State | FL
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Zip | 33351-6249
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Country | US
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Telephone | 954-787-8702
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Fax | 754-732-7441
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Provider Business Mailing Address
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Address Line | 4300 N UNIVERSITY DR # A153
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City | LAUDERHILL
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State | FL
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Zip | 33351-6249
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Country | US
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Telephone | 816-204-7632
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MRS. JESSICA OLADUMIYE
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Credential | LCSW
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Telephone | 954-787-8702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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