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General NPI Number Information
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NPI Number | 1861893653
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Entity Type | Organization
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Legal Business Name | CHILDREN'S PSYCHOLOGICAL SERVCIES CENTER
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 1664-2 METROPOLITAN CIRCLE
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City | TALLAHASSEE
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State | FL
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Zip | 32308
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Country | US
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Telephone | 850-508-6213
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Fax |
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Provider Business Mailing Address
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Address Line | 1664-2 METROPOLITAN CR
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City | TALLAHASSEE
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State | FL
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Zip | 32309
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED SCHOOL PSYCHOLOGIST
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Name | HOLLY DICKINSON
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Credential | ED.S.
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Telephone | 850-508-6213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SS621
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License Number State | FL
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