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General NPI Number Information
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NPI Number | 1811124613
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Entity Type | Organization
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Legal Business Name | TRCFL LLC
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 2898 MAHAN DR STE 6
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5462
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Country | US
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Telephone | 850-656-5112
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Fax | 850-656-3802
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Provider Business Mailing Address
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Address Line | 2724 CAPITAL CIR NE STE 8
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City | TALLAHASSEE
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State | FL
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Zip | 32308-1119
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Country | US
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Telephone | 850-656-5112
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Fax | 850-656-3802
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Authorized Official
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Title or Position | CEO/CLINICAL DIRECTOR
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Name | JACK RICHARDSON
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Credential | LCSW, DCSW, SAP
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Telephone | 850-656-5112
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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 | SW 4326
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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 | SW 4326
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License Number State | FL
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