Healthcare Provider Details

I. General information

NPI: 1003190406
Provider Name (Legal Business Name): INTERNATIONAL ASSOCIATION OF TRAUMA & ADDICTION COUNSELORS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 S STATE ROAD 7
PLANTATION FL
33317-4525
US

IV. Provider business mailing address

1030 S STATE ROAD 7
PLANTATION FL
33317-4525
US

V. Phone/Fax

Practice location:
  • Phone: 954-999-0818
  • Fax: 954-827-7636
Mailing address:
  • Phone: 549-999-0818
  • Fax: 954-827-7636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE LUTZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-999-0818