Organization
LISA WAVES OF CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA MCCUTCHEN (PRESIDENT)
(772) 332-7625
Entity
Organization
Contact information
Practice address
3403 AVENUE J, FORT PIERCE, FL 34947-2341
(772) 332-7625
Mailing address
3403 AVENUE J, FORT PIERCE, FL 34947-2341
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
01/04/2017
Last updated
01/04/2017
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