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1514 W Main St Leesburg FL 34748-4857 | |
| (352) 365-6506 | |
| (352) 365-6596 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1514 W Main St, Leesburg, Florida |
| Authorized Official Name and Position | Chrisann Reid-carrier (OWNER) |
| Authorized Official Contact | 3523656506 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1510 Park Dr Leesburg FL 34748-6738 Ph: (352) 365-6506 | 1514 W Main St Leesburg FL 34748-4857 Ph: (352) 365-6506 |
| NPI Number | 1457400939 |
|---|---|
| Provider Enumeration Date | 01/10/2007 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457400939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW8145 (Florida) | Primary |
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