| Peace Club | |
|
1811 S. Orlando Avenue Cocoa Beach FL 32931 | |
| (321) 961-5833 | |
| Not Available |
| Full Name | Peace Club |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 1811 S. Orlando Avenue, Cocoa Beach, Florida |
| Authorized Official Name and Position | Dennis Kolsch (OWNER) |
| Authorized Official Contact | 3214204656 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peace Club 1811 S Orlando Ave Cocoa Beach FL 32931-2340 Ph: (321) 961-5833 | Peace Club 1811 S. Orlando Avenue Cocoa Beach FL 32931 Ph: (321) 961-5833 |
| NPI Number | 1891206793 |
|---|---|
| Provider Enumeration Date | 10/18/2017 |
| Last Update Date | 01/24/2020 |
| Certification Date | 01/24/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891206793 | NPI | - | NPPES |
| MH13258 | Other | FL | LMHC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MH13258 (Florida) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 1000359 (Florida) | Primary |
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