Provider Demographics
NPI:1346543501
Name:A HEALING PLACE
Entity Type:Organization
Organization Name:A HEALING PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-433-0110
Mailing Address - Street 1:609 W CHASE ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-4711
Mailing Address - Country:US
Mailing Address - Phone:850-433-0110
Mailing Address - Fax:850-433-0188
Practice Address - Street 1:15 W STRONG ST
Practice Address - Street 2:SUITE 30B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3164
Practice Address - Country:US
Practice Address - Phone:850-433-0110
Practice Address - Fax:850-433-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty