Provider Demographics
NPI:1053057935
Name:MR AND MS MENTORING INC
Entity Type:Organization
Organization Name:MR AND MS MENTORING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:TARIQ
Authorized Official - Last Name:COLLINS EL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:386-262-9852
Mailing Address - Street 1:19 STARLING DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-1886
Mailing Address - Country:US
Mailing Address - Phone:386-262-9852
Mailing Address - Fax:
Practice Address - Street 1:1617 RIDGEWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-1750
Practice Address - Country:US
Practice Address - Phone:386-999-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty