Antidote Wellness LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ANTIDOTE WELLNESS LLC

Practice address

5435 Japonica Ave
Pensacola, FL 32507-8848

Phone

(850) 332-3087

NPI assigned

Oct 6, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amanda L Haggard, MSW, LCSWNPI 1871134494

Title

Sole Owner/Psychotherapist

Phone

(850) 332-3087

Specialties & licenses 1

Addresses

Other names 1

• Antidote Wellness LLC Former legal business name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amanda Leigh Haggard, MSW, LCSW, LISW CP

  • Clinical Social Worker
  • Pensacola, FL
  • NPI 1871134494

  Clinical

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601942400000",
    "number": "1043817786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5435 JAPONICA AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325078848",
            "telephone_number": "850-332-3087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5435 JAPONICA AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325078848",
            "telephone_number": "850-332-3087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTIDOTE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-06",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "HAGGARD",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SOLE OWNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "850-332-3087",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Antidote Wellness LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• All providers in Pensacola, FL
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.