Provider Demographics
NPI:1124851118
Name:EMBRACE WELLNESS CENTER LLC
Entity type:Organization
Organization Name:EMBRACE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILKS-YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:772-577-0405
Mailing Address - Street 1:985 SEAWAY DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34949-2744
Mailing Address - Country:US
Mailing Address - Phone:772-577-1697
Mailing Address - Fax:
Practice Address - Street 1:985 SEAWAY DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34949-2744
Practice Address - Country:US
Practice Address - Phone:772-577-1697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health