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General NPI Number Information
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NPI Number | 1477292118
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS FOR L.I.F.E.
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 6928 NW 30TH AVE # 6928
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1337
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Country | US
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Telephone | 954-947-1247
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Fax |
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Provider Business Mailing Address
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Address Line | 6928 NW 30TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1337
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Country | US
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Telephone | 954-594-6816
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Fax |
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Authorized Official
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Title or Position | LICENSED MARRIAGE & FAMILY THERAPIS
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Name | ANDROMEDA MOODIE
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Credential | LMFT
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Telephone | 954-594-6816
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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 |
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License Number State |
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