| Personal Wellness Solutions, Llc | |
|
550 N Reo St Ste 240 Tampa FL 33609-1062 | |
| (813) 435-3060 | |
| (813) 435-2345 |
| Full Name | Personal Wellness Solutions, Llc |
|---|---|
| Speciality | Counselor |
| Location | 550 N Reo St Ste 240, Tampa, Florida |
| Authorized Official Name and Position | Alicia Divico (OWNER) |
| Authorized Official Contact | 8134353060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Personal Wellness Solutions, Llc 550 N Reo St Ste 240 Tampa FL 33609-1062 Ph: (813) 435-3060 | Personal Wellness Solutions, Llc 550 N Reo St Ste 240 Tampa FL 33609-1062 Ph: (813) 435-3060 |
| NPI Number | 1639851512 |
|---|---|
| Provider Enumeration Date | 08/01/2023 |
| Last Update Date | 08/01/2023 |
| Certification Date | 08/01/2023 |
| Medicare PECOS PAC ID | 3476999533 |
|---|---|
| Medicare Enrollment ID | O20240312000111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639851512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Alicia Anne Divico |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013251180 PECOS PAC ID: 2961848510 Enrollment ID: I20240306001915 |
| Provider Name | Abbe Cotter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811142631 PECOS PAC ID: 3274679667 Enrollment ID: I20240319000163 |
| Provider Name | Kelly Lane |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225594005 PECOS PAC ID: 4183064454 Enrollment ID: I20240503000453 |
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