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General NPI Number Information
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NPI Number | 1508364118
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Entity Type | Organization
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Legal Business Name | CAPITAL CITY THERAPY
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 1931 WELBY WAY STE 3
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4473
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Country | US
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Telephone | 850-219-0973
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Fax | 850-574-0513
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Provider Business Mailing Address
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Address Line | 1931 WELBY WAY STE 3
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4473
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Country | US
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Telephone | 850-219-0973
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Fax | 850-574-0513
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Authorized Official
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Title or Position | OWNER
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Name | KAREN K FLEMING
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Credential | RN
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Telephone | 850-219-0973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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