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General NPI Number Information
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NPI Number | 1477727295
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Entity Type | Organization
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Legal Business Name | CENTER FOR LIFE TRANSITIONS, PA
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 1505 SE 40TH ST STE E
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City | CAPE CORAL
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State | FL
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Zip | 33904-7913
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Country | US
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Telephone | 239-549-8342
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 SE 40TH ST STE E
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City | CAPE CORAL
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State | FL
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Zip | 33904-7913
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Country | US
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Telephone | 239-549-8342
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CONSTANCE A STEGALL
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Credential | MFT
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Telephone | 239-549-8342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1991
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License Number State | FL
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