| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2933 Fl-434 #11, Longwood, Florida |
| Authorized Official Name and Position | Dawn Kendall (PRESIDENT) |
| Authorized Official Contact | 4073317717 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3355 Birnamwood Drive Colorado Springs CO 80920 Ph: (407) 538-4001 | 2933 Fl-434 #11 Longwood FL 32779 Ph: (407) 538-4001 |
| NPI Number | 1134363476 |
|---|---|
| Provider Enumeration Date | 04/30/2009 |
| Last Update Date | 05/10/2021 |
| Certification Date | 05/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134363476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MH6623 (Florida) | Secondary |
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