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Organization
SEAL THERAPEUTIC CORPORATION
Active
Organization
SEAL THERAPEUTIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE WOLLER LCSW (CLINICAL DIRECTOR)
(561) 715-5910
Entity
Organization
Contact information
Practice address
5818 SE AGNEW RD, BELLEVIEW, FL 34420-4020
(561) 715-5910
(561) 892-0268
Mailing address
2735 SE 140TH PL, SUMMERFIELD, FL 34491-2877
(561) 715-5910
(561) 892-0268
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
SW8553
FL
Other
Enumeration date
06/02/2008
Last updated
03/21/2024
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