| N/a | |
|
3501 Cortez Rd W Main Lobby Bradenton FL 34210-3104 | |
| (941) 795-7330 | |
| (941) 795-0181 |
| Full Name | N/a |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 3501 Cortez Rd W, Bradenton, Florida |
| Authorized Official Name and Position | Nelsie Eneida Walker (PRESIDENT) |
| Authorized Official Contact | 9418123977 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 5726 Cortez Rd W A-1 Bradenton FL 34210-2701 Ph: (941) 812-3977 | N/a 3501 Cortez Rd W Main Lobby Bradenton FL 34210-3104 Ph: (941) 795-7330 |
| NPI Number | 1861851354 |
|---|---|
| Provider Enumeration Date | 02/12/2016 |
| Last Update Date | 02/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861851354 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CAP #1489 (Florida) | Secondary |
| 101YM0800X | Counselor - Mental Health | LMHC #0003538 (Florida) | Primary |
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