Healthcare Provider Details

I. General information

NPI: 1174436042
Provider Name (Legal Business Name): CONNOR DRAWDY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E NEW YORK AVE STE C
DELAND FL
32724-5527
US

IV. Provider business mailing address

120 E NEW YORK AVE STE C
DELAND FL
32724-5527
US

V. Phone/Fax

Practice location:
  • Phone: 386-740-7110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: