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General NPI Number Information
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NPI Number | 1750453270
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Entity Type | Organization
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Legal Business Name | CENTER OF LIFE HEALTH, INC.
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 10/06/2010
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Provider Practice Location Address
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Address Line | 322 SW OCEAN BLVD
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City | STUART
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State | FL
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Zip | 34994
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Country | US
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Telephone | 772-220-4556
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Fax | 772-220-2214
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Provider Business Mailing Address
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Address Line | 322 SW OCEAN BLVD
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City | STUART
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State | FL
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Zip | 34994
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Country | US
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Telephone | 772-220-4556
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Fax | 772-220-2214
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. KATHLEEN SUE FULLER
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Credential | L.M.H.C.
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Telephone | 772-220-4556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MH3692
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MH3692
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License Number State | FL
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