Provider Demographics
NPI:1457853681
Name:HEALING PASSAGES LLC
Entity Type:Organization
Organization Name:HEALING PASSAGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-289-8606
Mailing Address - Street 1:5585 COVE CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9530
Mailing Address - Country:US
Mailing Address - Phone:239-289-8606
Mailing Address - Fax:
Practice Address - Street 1:5585 COVE CIR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-9530
Practice Address - Country:US
Practice Address - Phone:239-289-8606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-04
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW121501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty