Healthcare Provider Details

I. General information

NPI: 1073933479
Provider Name (Legal Business Name): NUDAWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 14TH ST
ORANGE CITY FL
32763-3116
US

IV. Provider business mailing address

1610 14TH ST
ORANGE CITY FL
32763-3116
US

V. Phone/Fax

Practice location:
  • Phone: 352-379-2829
  • Fax: 352-379-2843
Mailing address:
  • Phone: 386-561-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9640
License Number StateFL

VIII. Authorized Official

Name: MRS. MARGARET DAWN BILLINGS
Title or Position: THERAPIST
Credential: LMHC
Phone: 386-561-7757