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General NPI Number Information
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NPI Number | 1841887510
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Entity Type | Organization
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Legal Business Name | AIREDESCENT WELLNESS, PLLC
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 12330 METRIC BLVD APT 6214
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City | AUSTIN
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State | TX
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Zip | 78758-2523
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Country | US
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Telephone | 747-777-0503
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Fax |
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Provider Business Mailing Address
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Address Line | 10900 RESEARCH BLVD, STE 160C #2037
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City | AUSTIN
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State | TX
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Zip | 78759
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Country | US
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Telephone | 512-677-5115
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SEDERIA MOORE
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Credential | LCSW
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Telephone | 747-777-0503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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