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General NPI Number Information
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NPI Number | 1336938604
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Entity Type | Organization
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Legal Business Name | THE SOCIAL CENTER FOR DD AND ASD
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Dates
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Enumeration Date | 05/03/2025
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 875 MCPHERSON RD
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City | FORT WORTH
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State | TX
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Zip | 76140-5427
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Country | US
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Telephone | 817-870-6781
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Fax |
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Provider Business Mailing Address
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Address Line | 875 MCPHERSON RD
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City | FORT WORTH
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State | TX
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Zip | 76140-5427
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Country | US
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Telephone | 817-870-6781
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MCKENZE ALICIA VIRGIL
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Credential |
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Telephone | 817-870-6781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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