| The Full Fruit Empowerment Center | |
|
4650 S Hampton Rd Ste 119 Dallas TX 75232-1061 | |
| (682) 557-4695 | |
| Not Available |
| Full Name | The Full Fruit Empowerment Center |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 4650 S Hampton Rd Ste 119, Dallas, Texas |
| Authorized Official Name and Position | Delora Evans (OWNER/CEO/ EXE DIR) |
| Authorized Official Contact | 4697661251 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Full Fruit Empowerment Center 1512 Chama Dr Fort Worth TX 76119-2666 Ph: (469) 766-1251 | The Full Fruit Empowerment Center 4650 S Hampton Rd Ste 119 Dallas TX 75232-1061 Ph: (682) 557-4695 |
| NPI Number | 1144819996 |
|---|---|
| Provider Enumeration Date | 01/15/2021 |
| Last Update Date | 01/15/2021 |
| Certification Date | 01/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144819996 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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