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NPI Code Detail

MEDICARE: MS. DALLAS DRAWDY AS/BLS

MEDICARE: MS. DALLAS DRAWDY AS/BLS
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1144338385
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DALLAS DRAWDY AS/BLS
Provider Business Mailing Address
First Line : 7406 WINTER GARDEN PKWY
Second Line :
City : FORT PIERCE
State : FL
Zip : 34951-2707
Country : US
Telephone Number : 772-468-3910
Fax Number : 772-468-5620
Provider Business Practice Location Address
First Line : 404 IXORIA AVE
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-6250
Country : US
Telephone Number : 772-468-3910
Fax Number : 772-468-5620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2006
Last Update Date : 07/09/2007

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