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General NPI Number Information
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NPI Number | 1912893231
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Entity Type | Organization
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Legal Business Name | WADDLE SERVICES LLC
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 1262 TACOMA WAY
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City | DECATUR
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State | GA
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Zip | 30032-2437
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Country | US
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Telephone | 786-253-5802
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | AVONDALE ESTATES
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State | GA
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Zip | 30002-0458
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Country | US
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Telephone | 786-253-5802
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Fax |
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Authorized Official
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Title or Position | PARTNER & CO-CEO
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Name | MR. JAIME RAFAEL CABRE
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Credential |
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Telephone | 786-253-5802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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