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Organization
PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC.
Active
Organization
PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC.
Active
Other names
Pediatric Behavioral Health Associates of Marion County
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIKKI WOLLER PHD.,LCSW (PRESIDENT)
(561) 706-1004
Entity
Organization
Contact information
Practice address
5818 SE AGNEW RD, BELLEVIEW, FL 34420-4020
(561) 706-1004
(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
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
767023100
—
FL
Enumeration date
03/26/2019
Last updated
03/20/2024
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