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General NPI Number Information
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NPI Number | 1336218429
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Entity Type | Organization
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Legal Business Name | ECKERD YOUTH ALTERNATIVES INC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 500 E KU SUMEE DR
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City | CANDOR
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State | NC
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Zip | 27229-9058
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Country | US
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Telephone | 910-974-4183
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Fax | 910-974-7310
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Provider Business Mailing Address
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Address Line | 100 STARCREST DR
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City | CLEARWATER
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State | FL
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Zip | 33765-3224
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Country | US
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Telephone | 727-461-2990
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Fax | 727-216-0055
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Authorized Official
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Title or Position | CFO
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Name | NICOLE STROEBEL
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Credential |
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Telephone | 727-461-2990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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