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General NPI Number Information
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NPI Number | 1548775273
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Entity Type | Organization
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Legal Business Name | EMBRACE TO EMPOWER WELLNESS CENTER
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 4720 CLEVELAND HEIGHTS BLVD STE 305
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City | LAKELAND
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State | FL
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Zip | 33813-2246
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Country | US
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Telephone | 863-937-5599
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Fax | 863-816-5403
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Provider Business Mailing Address
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Address Line | 4720 CLEVELAND HEIGHTS BLVD STE 305
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City | LAKELAND
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State | FL
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Zip | 33813-2246
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Country | US
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Telephone | 863-937-5599
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Fax | 863-816-5403
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | LATAMIA M WHITE-GREEN
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Credential | MD
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Telephone | 863-937-5599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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