Healthcare Provider Details

I. General information

NPI: 1396088589
Provider Name (Legal Business Name): ATM TCM AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W COLONIAL DR SUITE 18
ORLANDO FL
32804-7139
US

IV. Provider business mailing address

1310 W COLONIAL DR SUITE 18
ORLANDO FL
32804-7139
US

V. Phone/Fax

Practice location:
  • Phone: 407-405-5052
  • Fax:
Mailing address:
  • Phone: 407-405-5052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA THOMPSON
Title or Position: SUPERVISOR/MANAGING PARTNER
Credential:
Phone: 407-405-5052