| Adolescent Wellness Academy Llc | |
|
4343 S State Road 7 Ste 103 Davie FL 33314-4009 | |
| (561) 816-9023 | |
| Not Available |
| Full Name | Adolescent Wellness Academy Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 4343 S State Road 7 Ste 103, Davie, Florida |
| Authorized Official Name and Position | Dustin Johnson (CEO) |
| Authorized Official Contact | 5618169023 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Adolescent Wellness Academy Llc 4343 S State Road 7 Ste 103 Davie FL 33314-4009 Ph: () - | Adolescent Wellness Academy Llc 4343 S State Road 7 Ste 103 Davie FL 33314-4009 Ph: (561) 816-9023 |
| NPI Number | 1386471084 |
|---|---|
| Provider Enumeration Date | 09/17/2024 |
| Last Update Date | 09/17/2024 |
| Certification Date | 09/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386471084 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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