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General NPI Number Information
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NPI Number | 1023682721
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Entity Type | Organization
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Legal Business Name | DCOA BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 208 SE 8TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1014
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Country | US
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Telephone | 954-593-2082
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Fax |
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Provider Business Mailing Address
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Address Line | 208 SE 8TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1014
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREG BREWTON
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Credential |
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Telephone | 954-593-2082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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