Healthcare Provider Details

I. General information

NPI: 1457176646
Provider Name (Legal Business Name): DRAGON TREE CENTER FOR SELF DEVELOPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E DE SOTO ST
PENSACOLA FL
32501-3337
US

IV. Provider business mailing address

1432 KINGS RD
CANTONMENT FL
32533-8943
US

V. Phone/Fax

Practice location:
  • Phone: 850-437-9997
  • Fax: 850-439-2122
Mailing address:
  • Phone: 850-723-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TRAM VUONG MEADOWS
Title or Position: OWNER
Credential: MA, LMHC
Phone: 850-723-4777