=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962700559
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRIENDS OF CHILDREN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2011
-----------------------------------------------------
Last Update Date | 03/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1718 SAN DAMIEN RD
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32303-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-264-4928
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1718 SAN DAMIEN RD
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32303-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-264-4928
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASTER LEVEL COUNSELOR THERAPIST
-----------------------------------------------------
Name | MRS. NICKITRA DENETRICE POPE-FORD
-----------------------------------------------------
Credential | MASTERS
-----------------------------------------------------
Telephone | 850-391-9116
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------