Provider Demographics
NPI:1922844174
Name:WINGS OF HOPE THERAPY CENTER LLC
Entity type:Organization
Organization Name:WINGS OF HOPE THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLDOVANYI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-994-0903
Mailing Address - Street 1:2825 N 10TH ST STE A2
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1872
Mailing Address - Country:US
Mailing Address - Phone:904-994-0903
Mailing Address - Fax:
Practice Address - Street 1:2825 N 10TH ST STE A2
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-1872
Practice Address - Country:US
Practice Address - Phone:904-994-0903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty