Provider Demographics
NPI:1851620926
Name:WTJ AND ASSOCIATES
Entity Type:Organization
Organization Name:WTJ AND ASSOCIATES
Other - Org Name:LIFE CHOICE AOLUTIONS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAYWARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC MCAP
Authorized Official - Phone:561-797-0480
Mailing Address - Street 1:7551 WILES RD STE 105A
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2064
Mailing Address - Country:US
Mailing Address - Phone:561-797-0480
Mailing Address - Fax:754-240-4953
Practice Address - Street 1:7551 WILES RD STE 105A
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2064
Practice Address - Country:US
Practice Address - Phone:561-797-0480
Practice Address - Fax:754-240-4953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL17-06-AD-747201261QM0801X
FL1706AD747201261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14560OtherFLORIDA DEPARTMENT OF HEALTH
FL14555OtherFLORIDA DEPARTMENT OF HEALTH
FL12003683OtherCAQH
FL12003631OtherCAQH