Organization
PEDIATRIC BEHAVIORAL HEALTH ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE WOLLER PHD, LCSW (PRESIDENT)
(561) 706-1004
Entity
Organization
Contact information
Practice address
5818 SE AGNEW RD, BELLEVIEW, FL 34420-4020
(561) 715-5910
Mailing address
2735 SE 140TH PL, SUMMERFIELD, FL 34491-2877
(561) 715-5910
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
01/23/2024
Last updated
03/20/2024
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