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General NPI Number Information
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NPI Number | 1245784610
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Entity Type | Organization
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Legal Business Name | PALM BEACH ADDICTION CENTER LLC
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4196 LAKE WORTH RD
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City | LAKE WORTH
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State | FL
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Zip | 33461-3933
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Country | US
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Telephone | 561-568-6188
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Fax |
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Provider Business Mailing Address
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Address Line | 4196 LAKE WORTH RD
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City | LAKE WORTH
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State | FL
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Zip | 33461-3933
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MR. MATT NOEL
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Credential |
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Telephone | 561-568-6787
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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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