Provider Demographics
NPI:1114201969
Name:THE CENTER FOR POSITIVE GROWTH, PLLC
Entity Type:Organization
Organization Name:THE CENTER FOR POSITIVE GROWTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:RINDOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-274-2850
Mailing Address - Street 1:2519 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4307
Mailing Address - Country:US
Mailing Address - Phone:954-696-9750
Mailing Address - Fax:
Practice Address - Street 1:2699 STIRLING RD STE C105
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6546
Practice Address - Country:US
Practice Address - Phone:954-696-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty