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General NPI Number Information
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NPI Number | 1750709556
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Entity Type | Organization
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Legal Business Name | AN INSTRUMENT OF HEALING AND PEACE
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 4591 E HIGHWAY 20 STE 202I
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City | NICEVILLE
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State | FL
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Zip | 32578-8844
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Country | US
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Telephone | 850-830-5904
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Fax | 850-279-3076
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Provider Business Mailing Address
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Address Line | 927 HOSPITAL DR
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City | NICEVILLE
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State | FL
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Zip | 32578-2707
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Country | US
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Telephone | 850-830-5904
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Fax | 850-279-3076
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Authorized Official
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Title or Position | OWNER
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Name | LINDA CARTER HARTMAN
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Credential | MA, LMFT
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Telephone | 850-830-5904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT2476
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License Number State | FL
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