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General NPI Number Information
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NPI Number | 1245552876
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Entity Type | Organization
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Legal Business Name | BECKY DURHAM-FLINT, P.A.
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 105 S RIVERSIDE DR SUITE 100
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City | INDIALANTIC
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State | FL
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Zip | 32903-4365
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Country | US
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Telephone | 321-733-2299
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Fax | 321-733-7515
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Provider Business Mailing Address
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Address Line | 105 S RIVERSIDE DR SUITE 100
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City | INDIALANTIC
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State | FL
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Zip | 32903-4365
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Country | US
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Telephone | 321-733-2299
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Fax | 321-733-7515
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Authorized Official
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Title or Position | OWNER
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Name | BECKY T DURHAM
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Credential | MSW, LCSW
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Telephone | 321-733-2299
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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 | 000389
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License Number State | FL
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