Healthcare Provider Details

I. General information

NPI: 1932018405
Provider Name (Legal Business Name): FOUNDATIONS HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 ROBERT J CONLAN BLVD NE STE 7
PALM BAY FL
32905-3559
US

IV. Provider business mailing address

1501 ROBERT J CONLAN BLVD NE STE 7
PALM BAY FL
32905-3559
US

V. Phone/Fax

Practice location:
  • Phone: 321-479-4083
  • Fax: 321-294-5036
Mailing address:
  • Phone:
  • Fax: 321-294-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTAL DICKUN
Title or Position: OWNER OF ENTITY
Credential: MD
Phone: 321-479-4083