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General NPI Number Information
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NPI Number | 1457853681
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Entity Type | Organization
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Legal Business Name | HEALING PASSAGES LLC
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Dates
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Enumeration Date | 03/04/2018
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 5585 COVE CIR
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City | NAPLES
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State | FL
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Zip | 34119-9530
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Country | US
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Telephone | 239-289-8606
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Fax |
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Provider Business Mailing Address
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Address Line | 5585 COVE CIR
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City | NAPLES
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State | FL
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Zip | 34119-9530
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Country | US
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Telephone | 239-289-8606
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Fax |
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Authorized Official
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Title or Position | LCSW/OWNER
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Name | MARIANA VANDIVIER
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Credential | LCSW
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Telephone | 239-289-8606
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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 | SW12150
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License Number State | FL
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