Provider Demographics
NPI:1033417985
Name:HOWARD, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32464-0121
Mailing Address - Country:US
Mailing Address - Phone:850-982-1293
Mailing Address - Fax:
Practice Address - Street 1:2380 HIGHWAY 179A
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:FL
Practice Address - Zip Code:32464-3093
Practice Address - Country:US
Practice Address - Phone:850-982-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690516196Medicaid
FL690516198Medicaid