Healthcare Provider Details

I. General information

NPI: 1124368832
Provider Name (Legal Business Name): LONG TERM CARE ADVOCATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 GULF BLVD SUITE 8
BELLEAIR BEACH FL
33786-3452
US

IV. Provider business mailing address

2100 GULF BLVD SUITE 8
BELLEAIR BEACH FL
33786-3452
US

V. Phone/Fax

Practice location:
  • Phone: 941-320-9819
  • Fax:
Mailing address:
  • Phone: 941-320-9819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number9475
License Number StateFL

VIII. Authorized Official

Name: DAWN M DOUCETTE
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 941-320-9819