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General NPI Number Information
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NPI Number | 1275702813
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Entity Type | Organization
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Legal Business Name | DYNAMIC POTENTIAL, L.C.
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 1550 MADRUGA AVE SUITE 331
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City | CORAL GABLES
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State | FL
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Zip | 33146-3039
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Country | US
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Telephone | 305-662-2173
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Fax | 305-662-2668
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Provider Business Mailing Address
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Address Line | 1550 MADRUGA AVENUE SUITE 331
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City | CORAL GABLES
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State | FL
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Zip | 33146-3071
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Country | US
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Telephone | 305-662-2173
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Fax | 305-662-2668
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. KIETH ALLEN MITCHELL
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Credential | D. MIN.
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Telephone | 305-662-2173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH1964
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License Number State | FL
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