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General NPI Number Information
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NPI Number | 1760973200
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Entity Type | Organization
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Legal Business Name | HEALING IN THE HOME COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 1825 NW CORPORATE BLVD STE 110
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City | BOCA RATON
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State | FL
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Zip | 33431-8554
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Country | US
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Telephone | 561-717-0470
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Fax | 561-717-0471
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Provider Business Mailing Address
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Address Line | 114 NE 13TH AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-3125
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Country | US
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Telephone | 561-729-4635
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Fax | 561-717-0471
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Authorized Official
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Title or Position | OWNER
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Name | TIA MARIE GLADDEN
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Credential | LCSW
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Telephone | 561-729-4635
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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 | SW11318
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License Number State | FL
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