Provider Demographics
NPI:1164403754
Name:COMMUNITY INTERVENTION CENTER, INC.
Entity Type:Organization
Organization Name:COMMUNITY INTERVENTION CENTER, INC.
Other - Org Name:CIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/CSWI
Authorized Official - Phone:850-222-3508
Mailing Address - Street 1:345 OFFICE PLZ
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2729
Mailing Address - Country:US
Mailing Address - Phone:850-222-3508
Mailing Address - Fax:850-222-3066
Practice Address - Street 1:345 OFFICE PLZ
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2729
Practice Address - Country:US
Practice Address - Phone:850-222-3508
Practice Address - Fax:850-222-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)