Provider Demographics
NPI:1558863787
Name:POSITIVE DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:POSITIVE DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-296-0626
Mailing Address - Street 1:3840 BELFORT RD STE 302
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8210
Mailing Address - Country:US
Mailing Address - Phone:904-516-0913
Mailing Address - Fax:
Practice Address - Street 1:3840 BELFORT RD STE 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8210
Practice Address - Country:US
Practice Address - Phone:904-516-0913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11373251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health