Healthcare Provider Details

I. General information

NPI: 1386784429
Provider Name (Legal Business Name): THE CHILDRENS ADVOCACY CENTER OF VOLUSIA & FLAGLER COUNTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W INTERNATIONAL SPEEDWAY BLVD
DAYTONA BEACH FL
32114-3421
US

IV. Provider business mailing address

1011 W INTERNATIONAL SPEEDWAY BLVD
DAYTONA BEACH FL
32114-3421
US

V. Phone/Fax

Practice location:
  • Phone: 386-238-3830
  • Fax: 386-257-7805
Mailing address:
  • Phone: 386-238-3830
  • Fax: 386-257-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. REGINALD WILLIAMS
Title or Position: CEO
Credential:
Phone: 386-238-3830