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General NPI Number Information
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NPI Number | 1174045025
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Entity Type | Organization
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Legal Business Name | EMERGING INTO NEW BEHAVIOR, INC.
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2755 BROADWAY
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-4538
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Country | US
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Telephone | 561-293-2433
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Fax | 561-628-7737
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Provider Business Mailing Address
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Address Line | PO BOX 10585
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City | RIVIERA BEACH
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State | FL
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Zip | 33419-0585
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Country | US
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Telephone | 561-293-2433
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Fax | 561-629-7737
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Authorized Official
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Title or Position | CEO
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Name | MR. PERCY WALKER JR.
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Credential |
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Telephone | 561-293-2433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5001
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | FL
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