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General NPI Number Information
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NPI Number | 1447295761
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC ALLIANCE COMMUNITY MENTAL HEALTH CENTER INC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 03/24/2012
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Provider Practice Location Address
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Address Line | 6405 NW 36TH ST SUITE 100
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6974
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Country | US
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Telephone | 305-871-3131
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Fax | 305-871-2727
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Provider Business Mailing Address
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Address Line | 6405 NW 36TH ST SUITE 100
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6974
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Country | US
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Telephone | 305-871-3131
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Fax | 305-871-2727
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DAYRA L BODAN
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Credential | PSY D
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Telephone | 305-871-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | HCC7230
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License Number State | FL
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