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General NPI Number Information
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NPI Number | 1679923338
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Entity Type | Individual
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Provider Name | Center for Sobriety, Spirituality & Healing
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Gender | Female
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 7100 W. Camino Real Suite 302-6
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City | Boca Raton
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State | FL
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Zip | 33433
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Country | US
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Telephone | 561-569-7372
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 W. Camino Real, Suite 302-6
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City | Boca Raton
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State | FL
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Zip | 33433
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Country | US
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Telephone | 561-504-8362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional
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License Number | MH13658
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License Number State | FL
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