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General NPI Number Information
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NPI Number | 1689143794
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Entity Type | Organization
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Legal Business Name | THE GIFT OF RECOVERY, LLC
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 1801 SW HILLMOOR DRIVE SUITE C-101
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City | PORT ST. LUCIE
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State | FL
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Zip | 34952
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Country | US
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Telephone | 954-805-0177
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Fax | 888-293-5884
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Provider Business Mailing Address
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Address Line | 1225 E RIVER DR
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City | MARGATE
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State | FL
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Zip | 33063-3635
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Country | US
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Telephone | 954-805-0177
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Fax | 888-293-5884
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Authorized Official
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Title or Position | CEO
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Name | MR. NATHANIEL HARDAGE JR.
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Credential |
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Telephone | 404-809-7764
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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 Counselor
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License Number |
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License Number State |
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