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General NPI Number Information
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NPI Number | 1710651583
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Entity Type | Organization
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Legal Business Name | ALL STAR CHILDREN'S FOUNDATION
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 3300 17TH ST
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City | SARASOTA
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State | FL
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Zip | 34235-8904
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Country | US
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Telephone | 941-259-3699
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Fax | 941-960-1123
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Provider Business Mailing Address
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Address Line | 3300 17TH ST
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City | SARASOTA
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State | FL
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Zip | 34235-8904
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Country | US
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Telephone | 941-259-3699
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Fax | 941-960-1123
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Authorized Official
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Title or Position | ACCOUNTANT
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Name | LADONNA CLARK
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Credential |
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Telephone | 941-259-3699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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