Healthcare Provider Details

I. General information

NPI: 1811124613
Provider Name (Legal Business Name): TRCFL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2898 MAHAN DR STE 6
TALLAHASSEE FL
32308-5462
US

IV. Provider business mailing address

2724 CAPITAL CIR NE STE 8
TALLAHASSEE FL
32308-1119
US

V. Phone/Fax

Practice location:
  • Phone: 850-656-5112
  • Fax: 850-656-3802
Mailing address:
  • Phone: 850-656-5112
  • Fax: 850-656-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW 4326
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSW 4326
License Number StateFL

VIII. Authorized Official

Name: JACK RICHARDSON
Title or Position: CEO/CLINICAL DIRECTOR
Credential: LCSW, DCSW, SAP
Phone: 850-656-5112