Organization Name: | TABULA RASA RENEWED |
NPI Number: | 1215279534 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CORDETT D MCCALL (PRESIDENT) |
Mailing Address: | 702 Park Lake St Orlando |
State: | FL US |
Postal Code: | 328034024 |
Phone Number: | 4072723700 |
Fax Number: | |
NPI Enumeration Date: | 03/25/2013 |
NPI Last Update Date: | 03/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |