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General NPI Number Information
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NPI Number | 1215277173
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Entity Type | Organization
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Legal Business Name | CENTER FOR DRUG FREE LIVING
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 1405 W MICHIGAN ST
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City | ORLANDO
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State | FL
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Zip | 32805-6123
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Country | US
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Telephone | 407-245-0020
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Fax | 407-650-6208
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Provider Business Mailing Address
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Address Line | 1405 W MICHIGAN ST
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City | ORLANDO
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State | FL
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Zip | 32805-6123
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Country | US
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Telephone | 407-245-0020
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Fax | 407-650-6208
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Authorized Official
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Title or Position | HOUSING CASE MANAGER
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Name | SHANNON MARIE OLESEN
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Credential | LCSW
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Telephone | 407-245-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | SW 10825
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License Number State | FL
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