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General NPI Number Information
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NPI Number | 1255791729
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Entity Type | Organization
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Legal Business Name | AC ASPIRE LLC
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 2425 E COMMERCIAL BLVD STE 400
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4029
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Country | US
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Telephone | 305-244-8763
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Fax |
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Provider Business Mailing Address
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Address Line | 4584 SW 113TH AVENUE BLDG 7 APT 312
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City | PEMBROKE PINES
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State | FL
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Zip | 33025
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Country | US
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Telephone | 305-244-8763
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. WYNETTE B GREEN
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Credential | LMFT
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Telephone | 305-244-8763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT2794
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License Number State | FL
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