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General NPI Number Information
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NPI Number | 1467405597
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Entity Type | Organization
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Legal Business Name | POLK COUNTY DRUG COURT
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 255 N BROADWAY AVE
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City | BARTOW
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State | FL
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Zip | 33830-3912
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Country | US
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Telephone | 863-534-4983
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Fax | 863-534-5854
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Provider Business Mailing Address
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Address Line | 255 N BROADWAY AVE
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City | BARTOW
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State | FL
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Zip | 33830-3912
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Country | US
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Telephone | 863-534-4983
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Fax | 863-534-5854
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Authorized Official
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Title or Position | DRUG COURT MANAGER
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Name | MR. JIM B. HORNSBY SR.
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Credential | L.M.H.C., C.A.P.
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Telephone | 863-534-4503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1453AD187401
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License Number State | FL
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