Healthcare Provider Details

I. General information

NPI: 1730784406
Provider Name (Legal Business Name): AVID INTELLECTUAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 HAMILTON DR LOT 35
FORT MYERS FL
33905-4428
US

IV. Provider business mailing address

6280 HAMILTON DR LOT 35
FORT MYERS FL
33905-4428
US

V. Phone/Fax

Practice location:
  • Phone: 786-505-4543
  • Fax:
Mailing address:
  • Phone: 786-505-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CANDACE DRUMMOND
Title or Position: OWNER
Credential: LMHC, BCBA
Phone: 786-505-4543