Organization Name: | WILLIAM L ROSS |
NPI Number: | 1083834246 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIAM L ROSS (BUSINESS OWNER) |
Mailing Address: | 1405 Park Ave Suite 202 Fernandina Beach |
State: | FL US |
Postal Code: | 320341950 |
Phone Number: | 9042772052 |
Fax Number: | 9042772083 |
NPI Enumeration Date: | 04/27/2007 |
NPI Last Update Date: | 06/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH6579 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |