Provider Demographics
NPI:1508112228
Name:COMMUNITY INTERVENTION CENTER
Entity Type:Organization
Organization Name:COMMUNITY INTERVENTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NJERIA
Authorized Official - Middle Name:OTIKA KAMILAH
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:850-222-3508
Mailing Address - Street 1:1353-B CROSS CREEK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301
Mailing Address - Country:US
Mailing Address - Phone:850-222-3508
Mailing Address - Fax:850-222-3066
Practice Address - Street 1:1353-B CROSS CREEK CIRCLE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301
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:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health