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General NPI Number Information
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NPI Number | 1093041154
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Entity Type | Organization
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Legal Business Name | CENTER FOR INDEPENDENT LIVING IN CENTRAL FLORIDA
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 720 N. DENNING DR.
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City | WINTER PARK
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State | FL
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Zip | 32789
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Country | US
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Telephone | 407-623-1070
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Fax | 407-623-1390
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Provider Business Mailing Address
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Address Line | 720 N. DENNING DR.
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City | WINTER PARK
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State | FL
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Zip | 32789
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Country | US
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Telephone | 407-623-1070
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Fax | 407-623-1390
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | MRS. TINA P JACK
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Credential | MS
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Telephone | 407-623-1070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH8933
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License Number State | FL
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