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General NPI Number Information
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NPI Number | 1619211091
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Entity Type | Organization
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Legal Business Name | NASSAU ALCOHOL CRIME DRUG ABATEMENT COALITION
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 435 CITRONA DR
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-2741
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Country | US
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Telephone | 904-261-5714
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Fax |
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Provider Business Mailing Address
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Address Line | 435 CITRONA DR
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-2741
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SUSAN WOODFORD
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Credential | MS
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Telephone | 904-335-1597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0445AD650601
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License Number State | FL
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