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General NPI Number Information
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NPI Number | 1548986052
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL WELLNESS GROUP, LLC
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 1311 N PAUL RUSSELL RD STE B102
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City | TALLAHASSEE
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State | FL
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Zip | 32301-4880
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Country | US
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Telephone | 850-759-7332
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 N PAUL RUSSELL RD STE B102
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City | TALLAHASSEE
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State | FL
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Zip | 32301-4880
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Country | US
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Telephone | 850-759-7332
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. SYLWIA PATRYCJA HODOREK
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Credential |
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Telephone | 850-759-7332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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