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General NPI Number Information
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NPI Number | 1417385998
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Entity Type | Organization
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Legal Business Name | FROM CHAINS TO GLORY ENTERPRISE
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Dates
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Enumeration Date | 10/21/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 1363 AKRON OAKS DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-4274
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Country | US
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Telephone | 202-497-5633
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Fax |
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Provider Business Mailing Address
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Address Line | 1363 AKRON OAKS DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-4274
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Country | US
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Telephone | 202-497-5633
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOY L. DOZIER-SMITH
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Credential | LCSW
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Telephone | 202-497-5633
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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 | SW11417
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License Number State | FL
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