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General NPI Number Information
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NPI Number | 1952011264
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Entity Type | Organization
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Legal Business Name | ADVANCED DIAGNOSTIC ASSESSMENTS & PSYCHOTHERAPY, INC.
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 130 S INDIAN RIVER DR STE 202
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City | FORT PIERCE
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State | FL
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Zip | 34950-4353
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Country | US
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Telephone | 772-324-9615
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Fax |
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Provider Business Mailing Address
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Address Line | 130 S INDIAN RIVER DR STE 202
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City | FORT PIERCE
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State | FL
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Zip | 34950-4353
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Country | US
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Telephone | 772-324-9615
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Fax |
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Authorized Official
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Title or Position | CEO/DIRECTOR/OWNER
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Name | DR. ALETHIA DUPONT
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Credential | PSY. D.
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Telephone | 772-324-9615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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