Provider Demographics
NPI:1417390246
Name:SUBSTANCE ABUSE COALITION OF COLLIER COUNTY
Entity Type:Organization
Organization Name:SUBSTANCE ABUSE COALITION OF COLLIER COUNTY
Other - Org Name:DRUG FREE COLLIER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-377-0516
Mailing Address - Street 1:PO BOX 770759
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34107-0759
Mailing Address - Country:US
Mailing Address - Phone:239-377-0516
Mailing Address - Fax:239-377-0506
Practice Address - Street 1:5775 OSCEOLA TRL
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0919
Practice Address - Country:US
Practice Address - Phone:239-377-0516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable