MEDICARE: GENUINE CAREGIVER SUPPORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	MH13177	FL
2	251S00000X	Community/Behavioral Health Agency	MH13177	FL
3	101YM0800X	Mental Health Counselor	MH13177	FL

General Provider Information

NPI Number	:	1568849354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENUINE CAREGIVER SUPPORT

Provider Business Mailing Address
First Line	:	6587 BLVD OF CHAMPIONS
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-3811
Country	:	US
Telephone Number	:	954-802-8185
Fax Number	:

Provider Business Practice Location Address
First Line	:	6587 BLVD OF CHAMPIONS
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-3811
Country	:	US
Telephone Number	:	954-802-8185
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PROF. CANDACE DRUMMOND
Credential	:	LMHC
Telephone Number	:	954-802-8185

Provider Enumeration Date	:	04/30/2015
Last Update Date	:	04/30/2015

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