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3596 Tamiami Trl Ste 205 Port Charlotte FL 33952-8252 | |
| (941) 255-5900 | |
| (941) 764-8285 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 3596 Tamiami Trl Ste 205, Port Charlotte, Florida |
| Authorized Official Name and Position | Barry K Wyrick (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 9412555900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3596 Tamiami Trl Ste 205 Port Charlotte FL 33952-8252 Ph: (941) 255-5900 | 3596 Tamiami Trl Ste 205 Port Charlotte FL 33952-8252 Ph: (941) 255-5900 |
| NPI Number | 1164822193 |
|---|---|
| Provider Enumeration Date | 08/27/2014 |
| Last Update Date | 08/27/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164822193 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 2008AD655206 (Florida) | Primary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
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