Healthcare Provider Details

I. General information

NPI: 1629367768
Provider Name (Legal Business Name): DELTA AGENCIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N ORLANDO AVE 313 PMB 220
WINTER PARK FL
32789-7313
US

IV. Provider business mailing address

501 N ORLANDO AVE 313 PMB 220
WINTER PARK FL
32789-7313
US

V. Phone/Fax

Practice location:
  • Phone: 407-622-6121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateFL

VIII. Authorized Official

Name: LEROY SCOTT
Title or Position: PRESIDENT
Credential:
Phone: 407-622-6121