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Organization
LOOSELEAF HOLISTIC WELLNESS
Active
Organization
LOOSELEAF HOLISTIC WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LETITIA LAURIEN LCSW (CHIEF EXECUTIVE OFFICER)
(772) 678-1397
Entity
Organization
Contact information
Practice address
3603 WILDERNESS DR E, FORT PIERCE, FL 34982-6562
(772) 208-8773
Mailing address
290 NW PEACOCK BLVD UNIT 881444, PORT ST LUCIE, FL 34988-5063
(772) 208-8773
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
12/07/2020
Last updated
07/17/2023
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