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General NPI Number Information
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NPI Number | 1568849354
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Entity Type | Organization
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Legal Business Name | GENUINE CAREGIVER SUPPORT
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 6587 BLVD OF CHAMPIONS
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-3811
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Country | US
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Telephone | 954-802-8185
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Fax |
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Provider Business Mailing Address
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Address Line | 6587 BLVD OF CHAMPIONS
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-3811
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Country | US
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Telephone | 954-802-8185
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PROF. CANDACE DRUMMOND
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Credential | LMHC
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Telephone | 954-802-8185
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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 | MH13177
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH13177
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13177
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License Number State | FL
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