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Organization

HARBOR HEALTH INTEGRATED CARE CLINIC

Active
Parent organization
HEART OF HARBOR INTEGRATED CARE INC
Organization subpart
Yes

Provider details

NPI number
Legal business name
HEART OF HARBOR INTEGRATED CARE INC
Authorized official
WILDINE BURGESS (EXECUTIVE ADMIN)
(240) 350-2863
Entity
Organization

Contact information

Practice address
4805 W THOMAS RD, PHOENIX, AZ 85031-4050
(602) 825-1659
Mailing address
4805 W THOMAS RD, PHOENIX, AZ 85031-4050
(602) 825-1659

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
103TC0700X
Clinical Psychologist
103TP2701X
Group Psychotherapy Psychologist
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
2084P0800X
Psychiatry Physician
261QM0850X
Adult Mental Health Clinic/Center
Primary
261QP2300X
Primary Care Clinic/Center
363L00000X
Nurse Practitioner
363LP2300X
Primary Care Nurse Practitioner

Other

Enumeration date
08/02/2022
Last updated
08/02/2022
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