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 (CEO)
(240) 350-2863
Entity
Organization
Contact information
Practice address
4805 W THOMAS RD, PHOENIX, AZ 85031-4050
(602) 825-1659
Mailing address
4908 W SIESTA WAY, LAVEEN, AZ 85339-4229
(240) 350-2863
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
07/27/2022
Last updated
07/27/2022
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