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General NPI Number Information
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NPI Number | 1851258776
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS HEALTH CENTERS
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 1501 ROBERT J CONLAN BLVD NE STE 7
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City | PALM BAY
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State | FL
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Zip | 32905-3559
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Country | US
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Telephone | 321-479-4083
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Fax | 321-294-5036
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Provider Business Mailing Address
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Address Line | 1501 ROBERT J CONLAN BLVD NE STE 7
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City | PALM BAY
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State | FL
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Zip | 32905-3559
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Country | US
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Telephone | 321-479-4083
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Fax | 321-294-5036
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Authorized Official
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Title or Position | OWNER, CEO
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Name | DR. CHRISTAL DICKUN
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Credential | MD
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Telephone | 860-204-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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