Provider Demographics
NPI:1053902767
Name:ALL WELLNESS COMMUNITY CENTER INC
Entity type:Organization
Organization Name:ALL WELLNESS COMMUNITY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANIA
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-416-0811
Mailing Address - Street 1:1150 NW 72ND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1920
Mailing Address - Country:US
Mailing Address - Phone:786-416-0811
Mailing Address - Fax:786-558-5483
Practice Address - Street 1:10671 N KENDALL DR STE 5D
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1510
Practice Address - Country:US
Practice Address - Phone:786-416-0811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11801500Medicaid