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General NPI Number Information
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NPI Number | 1932140126
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Entity Type | Organization
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Legal Business Name | U.S. DEPARTMENT OF VETERANS AFFAIRS ORLANDO VA HEALTHCARE CENTER
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5201 RAYMOND ST
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City | ORLANDO
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State | FL
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Zip | 32803-8208
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Country | US
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Telephone | 407-599-1472
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Fax | 407-599-1472
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Provider Business Mailing Address
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Address Line | 2001 GLENRIDGE WAY APARTMENT #48
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City | WINTER PARK
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State | FL
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Zip | 32792
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Country | US
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Telephone | 407-629-6360
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Fax | 407-599-1472
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Authorized Official
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Title or Position | SOCIAL WORK
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Name | MR. DORNELL MISTER
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Credential |
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Telephone | 407-599-1472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2-00571
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License Number State | MI
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