Healthcare Provider Details

I. General information

NPI: 1376436675
Provider Name (Legal Business Name): MCWAL COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 HERON BAY BLVD STE 200
CORAL SPRINGS FL
33076-3362
US

IV. Provider business mailing address

5780 NW 121ST AVE
CORAL SPRINGS FL
33076-4018
US

V. Phone/Fax

Practice location:
  • Phone: 954-422-7765
  • Fax:
Mailing address:
  • Phone: 954-422-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JULIA MCDONALD-WALCOTT
Title or Position: CEO
Credential:
Phone: 954-422-7765