| Well Space, Llc | |
|
4206 Del Prado Blvd S Cape Coral FL 33904-7154 | |
| (239) 677-6664 | |
| Not Available |
| Full Name | Well Space, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4206 Del Prado Blvd S, Cape Coral, Florida |
| Authorized Official Name and Position | Katia Jasmin Robinson Lucero (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2396776664 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Well Space, Llc 3606 14th St Sw Lehigh Acres FL 33976-2949 Ph: (239) 677-6664 | Well Space, Llc 4206 Del Prado Blvd S Cape Coral FL 33904-7154 Ph: (239) 677-6664 |
| NPI Number | 1366030934 |
|---|---|
| Provider Enumeration Date | 01/08/2021 |
| Last Update Date | 01/08/2021 |
| Certification Date | 12/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366030934 | NPI | - | NPPES |
| 018998800 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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