Healthcare Provider Details

I. General information

NPI: 1912242082
Provider Name (Legal Business Name): CENTER FOR LIFE CHANGING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10651 HABITAT TRL
BOKEELIA FL
33922-3122
US

IV. Provider business mailing address

10651 HABITAT TRL
BOKEELIA FL
33922-3122
US

V. Phone/Fax

Practice location:
  • Phone: 239-247-2327
  • Fax:
Mailing address:
  • Phone: 239-247-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSW7193
License Number StateFL

VIII. Authorized Official

Name: JODI L CARLTON
Title or Position: THERAPIST
Credential: LCSW
Phone: 239-247-2327