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General NPI Number Information
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NPI Number | 1699206920
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Entity Type | Organization
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Legal Business Name | THERESA A. INMAN, INC.
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 8842 FIELDSIDE CT
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City | JACKSONVILLE
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State | FL
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Zip | 32244-7456
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Country | US
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Telephone | 863-697-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 8842 FIELDSIDE CT
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City | JACKSONVILLE
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State | FL
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Zip | 32244-7456
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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 | PRESIDENT
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Name | THERESA Y ALEXANDER INMAN
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Credential | BCBA
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Telephone | 863-697-2700
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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 | 1-12-12371
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License Number State | FL
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