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General NPI Number Information
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NPI Number | 1275887598
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Entity Type | Organization
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Legal Business Name | ATLANTIC FAMILY INSTITUTE
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 808 3RD ST STE C
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266-5081
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Country | US
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Telephone | 904-247-5669
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Fax |
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Provider Business Mailing Address
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Address Line | 808 3RD ST STE C
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266-5081
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Country | US
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Telephone | 904-247-5669
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MR. RICHARD SCOTT HERBERT
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Credential | M.ED., ED.S.
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Telephone | 904-247-5669
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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 | MT0001341
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License Number State | FL
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