Provider Demographics
NPI:1053706507
Name:SUCCESSFUL WOMEN ACKNOWLEDGED
Entity type:Organization
Organization Name:SUCCESSFUL WOMEN ACKNOWLEDGED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:BS MS CWCM, CPI
Authorized Official - Phone:904-566-0200
Mailing Address - Street 1:5991 CHESTER AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5991 CHESTER AVE STE 211
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2245
Practice Address - Country:US
Practice Address - Phone:904-566-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUCCESSFUL WOMEN ACKNOWLEDGED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3852251B00000X, 251K00000X, 251S00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable