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General NPI Number Information
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NPI Number | 1356646921
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Entity Type | Organization
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Legal Business Name | HIBISCUS CHILDRENS CENTER
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 5091 E PORTOFINO LANDINGS BLVD UNIT 201
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City | FORT PIERCE
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State | FL
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Zip | 34947-5444
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Country | US
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Telephone | 772-882-4074
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Fax |
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Provider Business Mailing Address
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Address Line | 5091 E PORTOFINO LANDINGS BLVD UNIT 201
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City | FORT PIERCE
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State | FL
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Zip | 34947-5444
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | CHERON BUTLER
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Credential | MA
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Telephone | 772-882-4074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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