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General NPI Number Information
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NPI Number | 1770456725
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Entity Type | Organization
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Legal Business Name | JAMES CLUB MENTAL HEALTH & ADDICTION COUNSELING CENTER, INC
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 2650 N ANDREWS AVE
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City | WILTON MANORS
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State | FL
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Zip | 33311-2550
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Country | US
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Telephone | 954-773-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 N ANDREWS AVE
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City | WILTON MANORS
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State | FL
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Zip | 33311-2550
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Country | US
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Telephone | 954-773-4700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TRACEY VANESSA CASTILLO
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Credential |
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Telephone | 954-856-3676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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