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General NPI Number Information
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NPI Number | 1255146569
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Entity Type | Organization
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Legal Business Name | PRESTIGE ADDICTION TREATMENT CENTER
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 340 W 23RD ST STE C
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City | PANAMA CITY
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State | FL
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Zip | 32405-4541
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Country | US
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Telephone | 850-640-1554
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Fax |
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Provider Business Mailing Address
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Address Line | 2117 CAROLINE ST
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City | MANDEVILLE
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State | LA
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Zip | 70448-3707
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Country | US
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Telephone | 985-377-8909
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN NORRIS
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Credential |
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Telephone | 985-377-8909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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