Organization
EMERALD COAST WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY ALEXANDER BOILINI MD (PSYCHIATRIST)
(850) 543-5678
Entity
Organization
Contact information
Practice address
138 BAYWIND DR, NICEVILLE, FL 32578-4800
(850) 398-4155
(850) 398-4142
Mailing address
138 BAYWIND DR, NICEVILLE, FL 32578-4800
(850) 398-4155
(850) 398-4142
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008056800
—
FL
Enumeration date
01/07/2010
Last updated
09/02/2015
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