Healthcare Provider Details

I. General information

NPI: 1245552876
Provider Name (Legal Business Name): BECKY DURHAM-FLINT, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S RIVERSIDE DR SUITE 100
INDIALANTIC FL
32903-4365
US

IV. Provider business mailing address

105 S RIVERSIDE DR SUITE 100
INDIALANTIC FL
32903-4365
US

V. Phone/Fax

Practice location:
  • Phone: 321-733-2299
  • Fax: 321-733-7515
Mailing address:
  • Phone: 321-733-2299
  • Fax: 321-733-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number000389
License Number StateFL

VIII. Authorized Official

Name: BECKY T DURHAM
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 321-733-2299