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General NPI Number Information
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NPI Number | 1780012187
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Entity Type | Organization
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Legal Business Name | RECIPROCATE 1906 LLC
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Dates
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Enumeration Date | 10/22/2013
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Last Update Date | 10/22/2013
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Provider Practice Location Address
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Address Line | 18425 NW 2ND AVE STE 330
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City | MIAMI
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State | FL
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Zip | 33169-4534
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Country | US
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Telephone | 786-916-3660
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Fax | 786-916-3662
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Provider Business Mailing Address
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Address Line | PO BOX 694881
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City | MIAMI
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State | FL
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Zip | 33269-1881
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Country | US
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Telephone | 786-916-3660
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Fax | 786-916-3662
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Authorized Official
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Title or Position | PRESIDENT
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Name | DUSTIN I GOLLOPP SR.
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Credential | M.S.
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Telephone | 786-916-3660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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