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General NPI Number Information
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NPI Number | 1477376598
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Entity Type | Organization
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Legal Business Name | SALT & LIGHT HEALING WELLNESS, LLC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 250 CATALONIA AVE STE 702
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City | CORAL GABLES
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State | FL
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Zip | 33134-6727
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Country | US
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Telephone | 321-405-2805
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Fax |
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Provider Business Mailing Address
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Address Line | 250 CATALONIA AVE STE 702
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City | CORAL GABLES
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State | FL
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Zip | 33134-6727
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Country | US
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Telephone | 305-761-4354
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | HEIDI GUEVARA
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Credential | M.S
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Telephone | 321-405-2805
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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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