Provider Demographics
NPI:1033005509
Name:INTEGRATIVE WELLNESS CLINIC
Entity type:Organization
Organization Name:INTEGRATIVE WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KORINA
Authorized Official - Middle Name:DANIELA
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-562-0741
Mailing Address - Street 1:16410 WINDSOR CAY BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-7306
Mailing Address - Country:US
Mailing Address - Phone:352-562-0741
Mailing Address - Fax:
Practice Address - Street 1:16410 WINDSOR CAY BLVD APT 102
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-7306
Practice Address - Country:US
Practice Address - Phone:352-562-0741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty