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General NPI Number Information
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NPI Number | 1366486680
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Entity Type | Organization
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Legal Business Name | TEEN CHALLENGE OF FLORIDA, INC.
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 25 W WEBSTER ST
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City | SEBREE
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State | KY
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Zip | 42455
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Country | US
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Telephone | 484-868-0584
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Fax |
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Provider Business Mailing Address
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Address Line | 15 W 10TH ST
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City | COLUMBUS
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State | GA
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Zip | 31901-2744
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Country | US
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Telephone | 706-596-8731
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Fax | 706-596-8732
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Authorized Official
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Title or Position | CEO
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Name | MR. BRICE MADDOCK
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Credential |
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Telephone | 706-596-8731
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 0759AD922801
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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