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General NPI Number Information
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NPI Number | 1861925737
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Entity Type | Organization
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Legal Business Name | RESTORATIVE WELLNESS VERO LLC
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 1365 18TH ST
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City | VERO BEACH
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State | FL
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Zip | 32960-3577
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Country | US
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Telephone | 772-579-6443
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Fax |
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Provider Business Mailing Address
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Address Line | 1587 LEXINGTON SQ SW
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City | VERO BEACH
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State | FL
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Zip | 32962-3432
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE RODRIGUEZ
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Credential |
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Telephone | 772-579-6443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH14487
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License Number State | FL
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