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General NPI Number Information
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NPI Number | 1245620327
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Entity Type | Organization
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Legal Business Name | MAJESTIC BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 1057 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4611
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Country | US
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Telephone | 386-253-9391
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Fax | 386-253-9391
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Provider Business Mailing Address
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Address Line | 1057 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4611
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Country | US
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Telephone | 386-253-9391
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Fax | 386-253-9391
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LA TOYA SHARNETT GREGORY
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Credential | MBA, CCJAP, CAP
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Telephone | 386-253-9391
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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 | 0764AD478701
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License Number State | FL
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