Organization Name: | DECIDE DIFFERENTLY, LLC |
NPI Number: | 1033548805 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHAKTI SUTRIASA (PSYCHOTHERAPSIT) |
Mailing Address: | 1850 43rd Ave C-11 Vero Beach |
State: | FL US |
Postal Code: | 329600504 |
Phone Number: | 7723212291 |
Fax Number: | |
NPI Enumeration Date: | 11/02/2013 |
NPI Last Update Date: | 11/02/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | SW 11579 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |