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General NPI Number Information
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NPI Number | 1700556875
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Entity Type | Organization
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Legal Business Name | LIFE CHANGING DEVELOPMENT CENTER
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 6191 ORANGE DR STE 6153B
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City | DAVIE
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State | FL
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Zip | 33314-3454
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Country | US
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Telephone | 833-277-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 6191 ORANGE DR STE 6153B
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City | DAVIE
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State | FL
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Zip | 33314-3454
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Country | US
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Telephone | 833-277-7733
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | RACQUEL BROWN-MORTIMER
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Credential | LCSW
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Telephone | 833-277-7733
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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 |
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License Number State |
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