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General NPI Number Information
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NPI Number | 1033678834
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Entity Type | Organization
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Legal Business Name | ADAPTIVE CONNECTION CONSULTANTS
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 333 LAS OLAS WAY APT 441
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2374
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Country | US
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Telephone | 561-809-1830
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Fax |
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Provider Business Mailing Address
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Address Line | 333 LAS OLAS WAY APT 441
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2374
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Country | US
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Telephone | 561-809-1830
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED RERESENTITIVE
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Name | MARLANA STAATS
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Credential | LCSW
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Telephone | 561-809-1830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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