Provider Demographics
NPI:1669619342
Name:ACHIEVE WELLNESS GROUP LLC
Entity type:Organization
Organization Name:ACHIEVE WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:IANNELLI
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:888-531-1313
Mailing Address - Street 1:13039 W LINEBAUGH AVE
Mailing Address - Street 2:BUILDING V, SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4483
Mailing Address - Country:US
Mailing Address - Phone:888-531-1313
Mailing Address - Fax:888-551-6035
Practice Address - Street 1:13039 W LINEBAUGH AVE
Practice Address - Street 2:BUILDING V, SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4483
Practice Address - Country:US
Practice Address - Phone:888-531-1313
Practice Address - Fax:888-551-6035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN5854Medicare PIN