Healthcare Provider Details

I. General information

NPI: 1811449259
Provider Name (Legal Business Name): GREENWAY RECOVERY CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E OCEAN AVE
LANTANA FL
33462-3236
US

IV. Provider business mailing address

230 E OCEAN AVE
LANTANA FL
33462-3236
US

V. Phone/Fax

Practice location:
  • Phone: 561-577-1990
  • Fax:
Mailing address:
  • Phone: 561-577-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 14213
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND2162
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 2290
License Number State
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MANDI DUGGAN
Title or Position: CEO
Credential: LMHC, LMFT, NCC, CC
Phone: 561-557-1990