Healthcare Provider Details

I. General information

NPI: 1699148924
Provider Name (Legal Business Name): ADDICTION TREATMENT ADVOCATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2487 S VOLUSIA AVE STE 109
ORANGE CITY FL
32763-7607
US

IV. Provider business mailing address

2487 S VOLUSIA AVE STE 109
ORANGE CITY FL
32763-7607
US

V. Phone/Fax

Practice location:
  • Phone: 386-960-7830
  • Fax:
Mailing address:
  • Phone: 386-960-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. VIRGINIA J LATIMER
Title or Position: CEO
Credential: CARN
Phone: 386-960-7830