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General NPI Number Information
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NPI Number | 1740677434
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Entity Type | Organization
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Legal Business Name | CHOSEN ONE ENTERTAINMENT, LLC
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 1200 BRICKELL AVE SUITE 1950
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City | MIAMI
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State | FL
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Zip | 33131-3214
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Country | US
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Telephone | 305-961-1618
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Fax |
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Provider Business Mailing Address
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Address Line | 14050 BISCAYNE BLVD APT 314
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33181-1537
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Country | US
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Telephone | 850-294-5855
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MISS DOMINIQUE WATSON
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Credential | LCSW
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Telephone | 305-961-1618
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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 | SW9163
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License Number State | FL
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