Provider Demographics
NPI:1346627270
Name:WELLNESS COUNSELING & RESIDENTIAL DETOXIFICATION SERVICES
Entity Type:Organization
Organization Name:WELLNESS COUNSELING & RESIDENTIAL DETOXIFICATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-266-7682
Mailing Address - Street 1:6300 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8363
Mailing Address - Country:US
Mailing Address - Phone:772-266-4771
Mailing Address - Fax:
Practice Address - Street 1:3650-3670 NE INDIAN RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957
Practice Address - Country:US
Practice Address - Phone:772-919-8685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility