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General NPI Number Information
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NPI Number | 1427648815
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Entity Type | Organization
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Legal Business Name | CHS
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 226 NE SANCHEZ AVE
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City | OCALA
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State | FL
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Zip | 34470-5871
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Country | US
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Telephone | 352-843-2168
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Fax |
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Provider Business Mailing Address
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Address Line | 104 SE 13TH LN
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City | GAINESVILLE
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State | FL
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Zip | 32601-8617
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Country | US
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Telephone | 352-256-5662
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | CHESTER DAVON ROSS
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Credential | MS
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Telephone | 352-256-5662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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