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2260 Glenwood Dr Winter Park FL 32792-3312 | |
| (845) 826-0727 | |
| (407) 892-8346 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 2260 Glenwood Dr, Winter Park, Florida |
| Authorized Official Name and Position | Bj Johnson (BILLING SPECIALIST) |
| Authorized Official Contact | 8458260727 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4820 Windbourne Way Saint Cloud FL 34772-6858 Ph: (845) 826-0727 | 2260 Glenwood Dr Winter Park FL 32792-3312 Ph: (845) 826-0727 |
| NPI Number | 1598284259 |
|---|---|
| Provider Enumeration Date | 09/13/2017 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598284259 | NPI | - | NPPES |
| 601184189 | Other | FL | MAGELLAN |
| 4879059 | Other | FL | AETNA |
| 020576300 | Medicaid | FL | |
| QJK6X | Other | FL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | MH14147 (Florida) | Primary |
| 101YM0800X | Counselor - Mental Health | MH14147 (Florida) | Secondary |
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