Healthcare Provider Details

I. General information

NPI: 1518087683
Provider Name (Legal Business Name): FAMILY INTERVENTION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NW 70TH AVE STE A
PLANTATION FL
33317-2349
US

IV. Provider business mailing address

350 NW 70TH AVE STE A
PLANTATION FL
33317-2349
US

V. Phone/Fax

Practice location:
  • Phone: 954-587-7522
  • Fax:
Mailing address:
  • Phone: 954-587-7522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAP 3256
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 6986
License Number StateFL

VIII. Authorized Official

Name: MRS. NICOLE E BUDDLE-DIAZ
Title or Position: PRESIDENT
Credential: LCSW
Phone: 954-224-5031