Healthcare Provider Details

I. General information

NPI: 1154324762
Provider Name (Legal Business Name): CHILDREN'S ADVOCACY CENTER OF SW FL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 BROADWAY STE B-1
FT MYERS FL
33901-8193
US

IV. Provider business mailing address

3900 BROADWAY STE B-1
FT MYERS FL
33901-8193
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-2808
  • Fax: 239-939-4794
Mailing address:
  • Phone: 239-939-2808
  • Fax: 239-939-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JILL TURNER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 239-939-2808