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General NPI Number Information
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NPI Number | 1417181983
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Entity Type | Organization
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Legal Business Name | IT TAKES A VILLAGE ENTERPRISES
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 5800 NATURAL BRIDGE AVE N/A
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City | SAINT LOUIS
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State | MO
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Zip | 63120-1434
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Country | US
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Telephone | 314-606-8908
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Fax | 314-395-7001
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Provider Business Mailing Address
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Address Line | PO BOX 38108
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City | SAINT LOUIS
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State | MO
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Zip | 63138-0108
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Country | US
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Telephone | 314-606-8908
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Fax | 314-395-7001
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Authorized Official
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Title or Position | EXECUTIVE OFFICER
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Name | MS. TONIA T. GREEN
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Credential | MSW, ACSW, LCSW
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Telephone | 314-606-8908
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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 | 2000165951
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License Number State | MO
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