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General NPI Number Information
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NPI Number | 1942519020
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Entity Type | Organization
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Legal Business Name | DISCOVER YOURSELF INCORPORATED
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Dates
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Enumeration Date | 10/06/2010
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 511 SE 5TH AVE APT. 1812
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-2984
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Country | US
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Telephone | 786-683-4331
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Fax |
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Provider Business Mailing Address
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Address Line | 511 SE 5TH AVE APT. 1812
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-2984
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Country | US
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Telephone | 786-683-4331
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIRSTEN LYNGVED SHEA
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Credential | LCSW
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Telephone | 786-683-4331
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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 | SW 10044
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License Number State | FL
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