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General NPI Number Information
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NPI Number | 1942840731
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Entity Type | Organization
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Legal Business Name | DIMENSIONS OF WELLNESS, INC., A NONPROFIT CORPORATION
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 17461 ALLEN RD
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City | MELVINDALE
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State | MI
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Zip | 48122-1026
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Country | US
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Telephone | 727-212-1383
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Fax |
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Provider Business Mailing Address
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Address Line | 17461 ALLEN RD
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City | MELVINDALE
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State | MI
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Zip | 48122-1026
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Country | US
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Telephone | 727-212-1383
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. TRACY LYNN GOMEZ
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Credential | PSYD
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Telephone | 727-212-1383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 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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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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