Healthcare Provider Details

I. General information

NPI: 1770153751
Provider Name (Legal Business Name): AIM TARGET PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 CLEVELAND AVE STE 100
FORT MYERS FL
33901-7049
US

IV. Provider business mailing address

3049 CLEVELAND AVE STE 100
FORT MYERS FL
33901-7049
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-3363
  • Fax:
Mailing address:
  • Phone: 239-939-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DAWN CLARK
Title or Position: CLINICAL DIRECTOR
Credential: LMHC, CAP
Phone: 239-939-3363