Healthcare Provider Details

I. General information

NPI: 1932415155
Provider Name (Legal Business Name): CTS ADDICTION & COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25166 MARION AVE STE 112
PUNTA GORDA FL
33950-4017
US

IV. Provider business mailing address

2215 RIO DE JANEIRO AVE
PUNTA GORDA FL
33983-8674
US

V. Phone/Fax

Practice location:
  • Phone: 941-467-6347
  • Fax:
Mailing address:
  • Phone: 941-467-6347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number4729CAP
License Number StateFL

VIII. Authorized Official

Name: KIMBERLY WILCOX
Title or Position: OWNER
Credential:
Phone: 941-467-6347