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General NPI Number Information
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NPI Number | 1982151627
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Entity Type | Organization
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Legal Business Name | TAYLOR COUNTY RECOVERY CENTER, INC.
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 1709 S JEFFERSON ST
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City | PERRY
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State | FL
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Zip | 32348-5612
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Country | US
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Telephone | 850-584-2772
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Fax |
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Provider Business Mailing Address
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Address Line | 1709 S JEFFERSON ST
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City | PERRY
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State | FL
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Zip | 32348-5612
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Country | US
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Telephone | 850-584-2772
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR/PROVIDER/CEO
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Name | MRS. JOYCE J FULLER
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Credential | MPSY, MCAP
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Telephone | 850-584-2772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | FL
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Taxonomy #2
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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 | FL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | FL
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