Provider Demographics
NPI:1063675213
Name:HEALING CIRCLE FOR CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:HEALING CIRCLE FOR CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN-HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-298-6561
Mailing Address - Street 1:9351 SW 165TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3448
Mailing Address - Country:US
Mailing Address - Phone:305-298-6561
Mailing Address - Fax:
Practice Address - Street 1:14869 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7928
Practice Address - Country:US
Practice Address - Phone:305-969-7102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health