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General NPI Number Information
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NPI Number | 1114277266
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Entity Type | Organization
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Legal Business Name | PIECES OF A DREAM COUNSELING CENTER
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 12543 TAMIAMI TRL S
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City | NORTH PORT
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State | FL
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Zip | 34287-1446
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Country | US
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Telephone | 941-237-1199
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Fax |
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Provider Business Mailing Address
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Address Line | 12543 TAMIAMI TRL S
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City | NORTH PORT
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State | FL
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Zip | 34287-1446
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Country | US
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Telephone | 941-237-1199
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST/ DIRECTOR
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Name | MR. CALVIN COLLINS SR.
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Credential | LMHC
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Telephone | 941-237-1199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11397
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License Number State | FL
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