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General NPI Number Information
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NPI Number | 1669897443
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Entity Type | Organization
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Legal Business Name | CATHY SUPON CONNOR LLC
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 05/23/2014
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Provider Practice Location Address
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Address Line | 429 S TYNDALL PKWY STE G
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City | PANAMA CITY
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State | FL
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Zip | 32404-6746
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Country | US
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Telephone | 850-381-3701
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Fax |
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Provider Business Mailing Address
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Address Line | 429 S TYNDALL PKWY STE G
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City | PANAMA CITY
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State | FL
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Zip | 32404-6746
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Country | US
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Telephone | 850-381-3701
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Fax |
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Authorized Official
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Title or Position | LCSW/OWNER
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Name | MRS. CATHY SUPON CONNOR
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Credential | LCSW
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Telephone | 850-381-1520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW8892
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License Number State | FL
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