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General NPI Number Information
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NPI Number | 1932674538
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Entity Type | Organization
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Legal Business Name | FLORIDA TREATMENT FOR CHANGE INC
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 2180 MARAVILLA LN STE 1
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City | FORT MYERS
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State | FL
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Zip | 33901-7221
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Country | US
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Telephone | 239-202-8993
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Fax |
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Provider Business Mailing Address
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Address Line | 2917 NE 4TH PL
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City | CAPE CORAL
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State | FL
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Zip | 33909-6804
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Country | US
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Telephone | 239-333-8079
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. KARI-ANNE SPILLER
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Credential |
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Telephone | 239-333-8079
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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