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General NPI Number Information
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NPI Number | 1518508100
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Entity Type | Organization
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Legal Business Name | WELLNESS CENTER FOR HEALING LLC
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 1990 N FEDERAL HWY STE B
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City | POMPANO BEACH
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State | FL
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Zip | 33062-1032
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Country | US
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Telephone | 561-252-9389
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Fax | 954-366-1430
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Provider Business Mailing Address
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Address Line | 1990 N FEDERAL HWY STE B
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City | POMPANO BEACH
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State | FL
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Zip | 33062-1032
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Country | US
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Telephone | 561-252-9389
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Fax | 954-366-1430
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Authorized Official
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Title or Position | CEO
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Name | SAMANTHA V HEWITT
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Credential |
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Telephone | 561-252-9389
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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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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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