Provider Demographics
NPI:1558895755
Name:DDP FAMILY & INDIVIDUAL COUNSELING, LLC
Entity Type:Organization
Organization Name:DDP FAMILY & INDIVIDUAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHLAGTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-540-4583
Mailing Address - Street 1:4455 BANYAN TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-5109
Mailing Address - Country:US
Mailing Address - Phone:954-540-4583
Mailing Address - Fax:
Practice Address - Street 1:7501 WILES RD
Practice Address - Street 2:SUITE 102B
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2063
Practice Address - Country:US
Practice Address - Phone:954-540-4583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW67361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6051AMedicare UPIN