Provider Demographics
NPI:1851576979
Name:THE CENTER FOR DRUG FREE LIVING
Entity Type:Organization
Organization Name:THE CENTER FOR DRUG FREE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-245-0045
Mailing Address - Street 1:3670 MAGUIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3071
Mailing Address - Country:US
Mailing Address - Phone:407-245-0045
Mailing Address - Fax:407-245-0049
Practice Address - Street 1:3670 MAGUIRE BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3071
Practice Address - Country:US
Practice Address - Phone:407-245-0045
Practice Address - Fax:407-245-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0748AD294103251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health