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General NPI Number Information
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NPI Number | 1821629536
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Entity Type | Organization
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Legal Business Name | FRONT PORCH COUNSELING
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Dates
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Enumeration Date | 01/31/2020
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 116 BAY ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-3234
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Country | US
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Telephone | 386-589-7833
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Fax |
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Provider Business Mailing Address
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Address Line | 779 OCEAN SHORE BLVD
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City | ORMOND BEACH
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State | FL
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Zip | 32176-4703
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Country | US
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Telephone | 386-589-7833
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Fax |
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Authorized Official
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Title or Position | CEO/LMHC
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Name | HOLLAN PUGH
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Credential | LMHC
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Telephone | 386-589-7833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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