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General NPI Number Information
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NPI Number | 1992100952
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Entity Type | Organization
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Legal Business Name | ACTIVE COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 11/01/2014
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Last Update Date | 11/01/2014
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Provider Practice Location Address
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Address Line | 1000 N HIATUS RD SUITE 140
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3097
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Country | US
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Telephone | 954-937-6306
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Fax | 954-450-2419
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Provider Business Mailing Address
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Address Line | 1000 N HIATUS RD SUITE 140
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3097
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Country | US
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Telephone | 954-937-6306
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Fax | 954-450-2419
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Authorized Official
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Title or Position | THERAPIST
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Name | STEPHANIE WRIGHT WILLIAMS
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Credential | M.ED
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Telephone | 954-937-6306
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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 | IMH 9898
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License Number State | FL
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