Organization Name: | ADDICTION AND INTERVENTION PROFESSIONALS, LLC. |
NPI Number: | 1023326014 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRIAN WILLIAM JACKSON (EXECUTIVE DIRECTOR) |
Mailing Address: | 352 Paseo Reyes Dr St Augustine |
State: | FL US |
Postal Code: | 320958464 |
Phone Number: | 9048088373 |
Fax Number: | 9048088390 |
NPI Enumeration Date: | 09/23/2010 |
NPI Last Update Date: | 09/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0405X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
Taxonomy Definition: |