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General NPI Number Information
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NPI Number | 1639635980
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Entity Type | Organization
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Legal Business Name | WAYSIDE HOUSE, INC.
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 328 NE 6TH AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33483-5517
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Country | US
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Telephone | 561-666-9154
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Fax | 561-294-0178
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Provider Business Mailing Address
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Address Line | 378 NE 6TH AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33483
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Country | US
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Telephone | 561-666-9168
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Fax | 561-294-0178
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Authorized Official
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Title or Position | CEO
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Name | LISA GAIL MCWHORTER
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Credential |
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Telephone | 561-666-9154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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