Healthcare Provider Details

I. General information

NPI: 1023373578
Provider Name (Legal Business Name): DTT COACHING SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9745 SW 184TH ST
PALMETTO BAY FL
33157-6932
US

IV. Provider business mailing address

9745 SW 184TH ST
PALMETTO BAY FL
33157-6932
US

V. Phone/Fax

Practice location:
  • Phone: 786-701-2401
  • Fax: 305-397-1287
Mailing address:
  • Phone: 786-701-2401
  • Fax: 305-397-1287

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. DAMARYS CLEMENT
Title or Position: SUPERVISOR
Credential: MS
Phone: 305-316-3788