Provider Demographics
NPI:1417523580
Name:KIRA DIONNE WELLNESS LLC
Entity Type:Organization
Organization Name:KIRA DIONNE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:TUKRIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LCDC, CART
Authorized Official - Phone:904-613-7836
Mailing Address - Street 1:13150 FM 529 RD STE 122
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-2557
Mailing Address - Country:US
Mailing Address - Phone:713-234-0680
Mailing Address - Fax:
Practice Address - Street 1:13150 FM 529 RD STE 122
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-2557
Practice Address - Country:US
Practice Address - Phone:713-234-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children