=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952855082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAY BY DAY WELLNESS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2016
-----------------------------------------------------
Last Update Date | 10/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 207 BLUE HERON BLVD E SUITE 203
-----------------------------------------------------
City | RIVIERA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33404-4560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-827-7409
-----------------------------------------------------
Fax | 561-244-8055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 207 BLUE HERON BLVD E SUITE 203
-----------------------------------------------------
City | RIVIERA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33404-4560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-827-7409
-----------------------------------------------------
Fax | 561-244-8055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DARREN WINGATE SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-827-7409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------