Healthcare Provider Details

I. General information

NPI: 1417100140
Provider Name (Legal Business Name): RESOLUTIONS HEALTH ALLIANCE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 W DUVAL ST
LAKE CITY FL
32055-3899
US

IV. Provider business mailing address

512 W DUVAL ST
LAKE CITY FL
32055-3899
US

V. Phone/Fax

Practice location:
  • Phone: 386-754-9005
  • Fax: 386-754-9017
Mailing address:
  • Phone: 386-754-9005
  • Fax: 386-754-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. ERIN E CRUMITIE
Title or Position: OWNER/ CEO
Credential:
Phone: 386-754-9005