Provider Demographics
NPI:1902186992
Name:HYGEIA AFFILIATES,LLC
Entity Type:Organization
Organization Name:HYGEIA AFFILIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIERNIK
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:240-235-5895
Mailing Address - Street 1:13601 PRESTON RD
Mailing Address - Street 2:SUITE 550E
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240
Mailing Address - Country:US
Mailing Address - Phone:240-235-5895
Mailing Address - Fax:972-559-3634
Practice Address - Street 1:1846 LOCKHILL SELMA RD,
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:78213
Practice Address - Country:US
Practice Address - Phone:301-591-4184
Practice Address - Fax:214-276-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32920103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty