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General NPI Number Information
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NPI Number | 1760829311
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Entity Type | Organization
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Legal Business Name | EAST COAST DRUG TESTING, LLC.
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 224 DATURA ST SUITE 402
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5624
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Country | US
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Telephone | 561-408-3929
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Fax |
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Provider Business Mailing Address
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Address Line | 159 NORTHAMPTON H
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-1744
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEREN ROESSER
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Credential |
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Telephone | 561-408-3929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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