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General NPI Number Information
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NPI Number | 1871771451
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Entity Type | Organization
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Legal Business Name | A STATE OF MIND COUNSELING AND WELLNESS CENTERS INC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 915 MIDDLE RIVER DR SUITE 317
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3544
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Country | US
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Telephone | 954-761-3869
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Fax | 954-463-1687
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Provider Business Mailing Address
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Address Line | 915 MIDDLE RIVER DR SUITE 317
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3544
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Country | US
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Telephone | 954-761-3869
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Fax | 954-463-1687
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. JUDITH ANN PECORARO
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Credential | BS, CBHT
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Telephone | 954-761-3869
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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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