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1400 Old Dixie Hwy Ste A St Augustine FL 32084-5733 | |
| (904) 829-2273 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1400 Old Dixie Hwy Ste A, St Augustine, Florida |
| Authorized Official Name and Position | Patricia Greenough (CEO) |
| Authorized Official Contact | 9048292273 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1400 Old Dixie Hwy Ste A St Augustine FL 32084-5733 Ph: (904) 829-2273 | 1400 Old Dixie Hwy Ste A St Augustine FL 32084-5733 Ph: (904) 829-2273 |
| NPI Number | 1740673417 |
|---|---|
| Provider Enumeration Date | 03/05/2015 |
| Last Update Date | 03/05/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740673417 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CAP1203 (Florida) | Primary |
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