Provider Demographics
NPI:1437739976
Name:DAHLIA WELLNESS LLC
Entity Type:Organization
Organization Name:DAHLIA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KASSANDRA
Authorized Official - Middle Name:SHUGARS
Authorized Official - Last Name:MCCUNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-392-9188
Mailing Address - Street 1:5290 DON MANUEL RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:FL
Mailing Address - Zip Code:32033-3220
Mailing Address - Country:US
Mailing Address - Phone:043-929-1889
Mailing Address - Fax:
Practice Address - Street 1:5290 DON MANUEL RD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:FL
Practice Address - Zip Code:32033-3220
Practice Address - Country:US
Practice Address - Phone:190-539-2918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty