MEDICARE: AVID INTELLECTUAL INC.

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1985	OTHER		YEAR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730784406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVID INTELLECTUAL INC.

Provider Business Mailing Address
First Line	:	6587 BOULEVARD OF CHAMPIONS
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-3811
Country	:	US
Telephone Number	:	305-692-0978
Fax Number	:

Provider Business Practice Location Address
First Line	:	6587 BOULEVARD OF CHAMPIONS
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-3811
Country	:	US
Telephone Number	:	305-692-0978
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR/MENTAL HEALTH
Name	:	CANDACE DRUUMOND
Credential	:	LMHC
Telephone Number	:	305-692-0978

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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