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General NPI Number Information
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NPI Number | 1730439118
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Entity Type | Organization
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Legal Business Name | DWIGHT COUNSELING SERVICE
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 2723 HIGHWAY 2
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City | BONIFAY
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State | FL
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Zip | 32425-6721
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Country | US
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Telephone | 850-547-3032
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Fax |
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Provider Business Mailing Address
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Address Line | 433 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-2731
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Country | US
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Telephone | 850-774-4692
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. DWIGHT T. REIGHTNOUR
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Credential | LMHC
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Telephone | 850-774-4692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | MH9708
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License Number State | FL
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