MEDICARE: MR. CHARLES LEE DINKINS MPA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP1600X	Pastoral Counselor
3	104100000X	Social Worker
4	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1659779387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES LEE DINKINS MPA

Provider Business Mailing Address
First Line	:	2171 NW 56TH STREET
Second Line	:	HOSANNA COMMUNITY FOUNDATION, INC.
City	:	MIAMI
State	:	FL
Zip	:	33142
Country	:	US
Telephone Number	:	305-610-4164
Fax Number	:	305-637-4474

Provider Business Practice Location Address
First Line	:	2171 NW 56TH ST
Second Line	:	HOSANNA COMMUNITY FOUNDATION, INC.
City	:	MIAMI
State	:	FL
Zip	:	33142-3011
Country	:	US
Telephone Number	:	305-610-4164
Fax Number	:	305-637-4474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	12/11/2014

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Directions to “ MR. CHARLES LEE DINKINS MPA” Practice Location

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