MEDICARE: MR AND MS MENTORING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1053057935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MR AND MS MENTORING INC

Provider Business Mailing Address
First Line	:	19 STARLING DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-1886
Country	:	US
Telephone Number	:	386-262-9852
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 RIDGEWOOD AVE
Second Line	:
City	:	HOLLY HILL
State	:	FL
Zip	:	32117-1798
Country	:	US
Telephone Number	:	386-999-0333
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DERRICK TARIQ COLLINS EL
Credential	:	M.S.W
Telephone Number	:	386-262-9852

Provider Enumeration Date	:	05/12/2022
Last Update Date	:	08/12/2024

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Directions to “MR AND MS MENTORING INC ” Practice Location

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