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General NPI Number Information
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NPI Number | 1497290407
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA CARES, INC.
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Dates
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Enumeration Date | 12/29/2016
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 1535 KILLEARN CENTER BLVD STE C-5
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City | TALLAHASSEE
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State | FL
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Zip | 32309-3467
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Country | US
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Telephone | 850-656-1192
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Fax | 850-386-1300
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Provider Business Mailing Address
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Address Line | 3111 MAHAN DR STE 20 PMB-2110
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5511
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Country | US
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Telephone | 850-656-1192
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Fax | 850-386-1300
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Authorized Official
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Title or Position | OWNER/LEAD PSYCHOLOGIST
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Name | DR. ANGELA L. HENDERSON
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Credential | PH.D.
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Telephone | 850-656-1192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7246
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License Number State | FL
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