Provider Demographics
NPI:1467405597
Name:POLK COUNTY DRUG COURT
Entity Type:Organization
Organization Name:POLK COUNTY DRUG COURT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRUG COURT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HORNSBY
Authorized Official - Suffix:SR
Authorized Official - Credentials:LMHC, CAP
Authorized Official - Phone:863-534-4503
Mailing Address - Street 1:255 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-3912
Mailing Address - Country:US
Mailing Address - Phone:863-534-4983
Mailing Address - Fax:863-534-5854
Practice Address - Street 1:255 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3912
Practice Address - Country:US
Practice Address - Phone:863-534-4983
Practice Address - Fax:863-534-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1453AD187401101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty