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4343 S State Road 7 Ste 101 Davie FL 33314-4009 | |
| (954) 368-1344 | |
| (954) 368-1345 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4343 S State Road 7 Ste 101, Davie, Florida |
| Authorized Official Name and Position | Dustin Johnson (ADMIN) |
| Authorized Official Contact | 5618169023 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4343 S State Road 7 Ste 101 Davie FL 33314-4009 Ph: () - | 4343 S State Road 7 Ste 101 Davie FL 33314-4009 Ph: (954) 368-1344 |
| NPI Number | 1639566409 |
|---|---|
| Provider Enumeration Date | 04/20/2015 |
| Last Update Date | 08/12/2024 |
| Certification Date | 08/12/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639566409 | NPI | - | NPPES |
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