=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992004907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGI PSYCHOTHERAPY SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2011
-----------------------------------------------------
Last Update Date | 03/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3401 SPRING ST 2ND FLOOR
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-2932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-933-2387
-----------------------------------------------------
Fax | 954-533-3046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3401 SPRING ST 2ND FLOOR
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-2932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-933-2387
-----------------------------------------------------
Fax | 954-533-3046
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. EUGENIA VALISHA DAVIS
-----------------------------------------------------
Credential | MS, LMHC
-----------------------------------------------------
Telephone | 954-684-1349
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 101YM0800X
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------