Basic Information
| Provider Information | |||||||||
| NPI: | 1639745789 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE LINA CENTER FOR MENTAL WELLNESS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17063 SW 215TH TER | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331874313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053036631 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17063 SW 215TH TER | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331874313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053036631 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2021 | ||||||||
| LastUpdateDate: | 05/31/2021 | ||||||||
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| AuthorizedOfficialLastName: | OLIVA-GARCIA | ||||||||
| AuthorizedOfficialFirstName: | ISBELL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3053036631 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
| NPICertificationDate: | 05/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.