Healthcare Provider Details

I. General information

NPI: 1407535446
Provider Name (Legal Business Name): ADRIENNE DENISE HUGGINS CBHCMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ADRIENNE DENISE MOSES

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SW SAINT LUCIE WEST BLVD STE 105
PORT SAINT LUCIE FL
34986-1779
US

IV. Provider business mailing address

1100 SW SAINT LUCIE WEST BLVD STE 105
PORT SAINT LUCIE FL
34986-1779
US

V. Phone/Fax

Practice location:
  • Phone: 386-283-7123
  • Fax:
Mailing address:
  • Phone: 386-283-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberCWLC.0104337-P
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: