Provider Demographics
NPI:1659533941
Name:HEALING CENTER OF MIAMI INC
Entity Type:Organization
Organization Name:HEALING CENTER OF MIAMI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO MAZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-254-5541
Mailing Address - Street 1:13200 SW 128 ST
Mailing Address - Street 2:SUITE D 3
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:305-254-5541
Mailing Address - Fax:
Practice Address - Street 1:13200 SW 128 ST
Practice Address - Street 2:SUITE D 3
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:305-254-5541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8367251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health