Healthcare Provider Details

I. General information

NPI: 1922545490
Provider Name (Legal Business Name): PREVENTIVE BEHAVIORS & SOLUTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 MARTINS RUN
TAVARES FL
32778-5181
US

IV. Provider business mailing address

2475 MARTINS RUN
TAVARES FL
32778-5181
US

V. Phone/Fax

Practice location:
  • Phone: 352-874-9802
  • Fax: 352-508-5079
Mailing address:
  • Phone: 352-874-9802
  • Fax: 352-508-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number000702100
License Number StateFL

VIII. Authorized Official

Name: VICTORA DENISE WEEKS
Title or Position: OWNER
Credential:
Phone: 352-874-9802