=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811509177
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DURAND HEALING AND WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2020
-----------------------------------------------------
Last Update Date | 02/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1918 W BONANZA LN
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85085-1727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-225-4960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 W DEER VALLEY RD STE 103-432
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85027-2138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-225-4960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANDREA D DURAND
-----------------------------------------------------
Credential | DBH,LCSW
-----------------------------------------------------
Telephone | 480-225-4960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------