NPIMap

Organization Active NPI

Adolescent Wellness Academy LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Coconut Creek, FL
National Provider Identifier
1235095704
Registry record updated Dec 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
ADOLESCENT WELLNESS ACADEMY LLC
Practice address
4611 Johnson Rd Ste A06
Coconut Creek, FL 33073-4361
Phone
(561) 816-9023
Fax
(954) 368-1345
NPI assigned
Dec 29, 2025
Last updated
Dec 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2025

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

Authorized official

Name
Dustin Johnson
Title
Ceo
Phone
(561) 816-9023

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

4611 Johnson Rd Ste A06
Coconut Creek, FL 33073-4361

Mailing address

4611 Johnson Rd Ste A06
Coconut Creek, FL 33073-4361
Phone (561) 816-9023

National Provider Directory

National Provider Directory
Tax ID family
Adolescent Wellness Academy LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4611 Johnson Rd
Ste A6
Coconut Creek, FL 33073
Phone (561) 816-9023

NPI Registry JSON

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

{
    "created_epoch": "1766966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766966400000",
    "number": "1235095704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4611 JOHNSON RD STE A06",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734361",
            "telephone_number": "561-816-9023",
            "fax_number": "954-368-1345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4611 JOHNSON RD STE A06",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734361",
            "telephone_number": "561-816-9023",
            "fax_number": "954-368-1345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADOLESCENT WELLNESS ACADEMY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-29",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-816-9023"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coconut Creek, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; 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.