Provider Demographics
NPI:1275916041
Name:THE SOCIAL HOUSE OF FLORIDA, LLC
Entity Type:Organization
Organization Name:THE SOCIAL HOUSE OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:770-330-8490
Mailing Address - Street 1:1971 FAIRWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4504
Mailing Address - Country:US
Mailing Address - Phone:770-330-8490
Mailing Address - Fax:
Practice Address - Street 1:1971 FAIRWAY LOOP
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4504
Practice Address - Country:US
Practice Address - Phone:770-330-8490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-18922103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty