Provider Demographics
NPI:1083149249
Name:LICENSED PROFESSIONALS
Entity Type:Organization
Organization Name:LICENSED PROFESSIONALS
Other - Org Name:HEWES COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:386-682-0788
Mailing Address - Street 1:595 N NOVA RD
Mailing Address - Street 2:111
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4424
Mailing Address - Country:US
Mailing Address - Phone:386-682-0788
Mailing Address - Fax:386-673-9000
Practice Address - Street 1:595 N NOVA RD
Practice Address - Street 2:111
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4424
Practice Address - Country:US
Practice Address - Phone:386-682-0788
Practice Address - Fax:386-673-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty