Healthcare Provider Details

I. General information

NPI: 1053508481
Provider Name (Legal Business Name): SEMINOLE COMMUNITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 E 2ND ST
SANFORD FL
32771-2101
US

IV. Provider business mailing address

919 E 2ND ST
SANFORD FL
32771-2101
US

V. Phone/Fax

Practice location:
  • Phone: 407-323-2036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number101YM0800X
License Number StateFL

VIII. Authorized Official

Name: MELISSA DAY
Title or Position: CO-OCCURING DISORDERS SPECIALIST
Credential: B.S., CAS
Phone: 407-323-2036