Provider Demographics
NPI:1285070920
Name:INNER HARBOR CENTER FOR WELLNESS LLC
Entity type:Organization
Organization Name:INNER HARBOR CENTER FOR WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST & FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DVORAK-FARLING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-504-3041
Mailing Address - Street 1:9160 OAKHURST RD
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776
Mailing Address - Country:US
Mailing Address - Phone:727-504-3041
Mailing Address - Fax:727-498-5522
Practice Address - Street 1:9160 OAKHURST RD
Practice Address - Street 2:SUITE 4B
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776
Practice Address - Country:US
Practice Address - Phone:727-504-3041
Practice Address - Fax:727-498-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW112181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty