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General NPI Number Information
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NPI Number | 1174214365
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Entity Type | Organization
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Legal Business Name | PROSOCIAL BEHAVIORAL HEALTH INCORPORATED
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 1216 SUMMIT OAKS DR W
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City | JACKSONVILLE
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State | FL
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Zip | 32221-3236
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Country | US
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Telephone | 904-673-0684
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Fax |
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Provider Business Mailing Address
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Address Line | 1216 SUMMIT OAKS DR W
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City | JACKSONVILLE
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State | FL
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Zip | 32221-3236
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Country | US
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Telephone | 904-673-0684
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. ANDREW SHERWIN GEORGE
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Credential | BCBA
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Telephone | 904-673-0684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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