Healthcare Provider Details

I. General information

NPI: 1023682721
Provider Name (Legal Business Name): DCOA BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SE 8TH ST
FORT LAUDERDALE FL
33316-1014
US

IV. Provider business mailing address

208 SE 8TH ST
FORT LAUDERDALE FL
33316-1014
US

V. Phone/Fax

Practice location:
  • Phone: 954-593-2082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: GREG BREWTON
Title or Position: OWNER
Credential:
Phone: 954-593-2082