Healthcare Provider Details

I. General information

NPI: 1912330176
Provider Name (Legal Business Name): BEAUTIFUL BUTTERFLIES MENTORING PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 VINEYARD CIR
SANFORD FL
32771-6844
US

IV. Provider business mailing address

2448 VINEYARD CIR
SANFORD FL
32771-6844
US

V. Phone/Fax

Practice location:
  • Phone: 850-443-3088
  • Fax:
Mailing address:
  • Phone: 850-443-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. LYNDORA FRAZIER
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential:
Phone: 850-443-3088