Provider Demographics
NPI:1619321593
Name:TD EDUCATIONAL SERVICES
Entity Type:Organization
Organization Name:TD EDUCATIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GUIDANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:954-536-1456
Mailing Address - Street 1:3701 COCOPLUM CIR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5934
Mailing Address - Country:US
Mailing Address - Phone:954-536-1456
Mailing Address - Fax:
Practice Address - Street 1:3701 COCOPLUM CIR
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-5934
Practice Address - Country:US
Practice Address - Phone:954-536-1456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL886298101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty