Provider Demographics
NPI:1861689135
Name:CFSATC INC
Entity Type:Organization
Organization Name:CFSATC INC
Other - Org Name:CENTRAL FLORIDA TREATMENT CENTERS FORT PIERCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEESSY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MAC, MCAP, LMHC
Authorized Official - Phone:321-951-9750
Mailing Address - Street 1:1302 N LAWNWOOD CIR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4884
Mailing Address - Country:US
Mailing Address - Phone:772-468-6800
Mailing Address - Fax:772-464-3800
Practice Address - Street 1:1302 N LAWNWOOD CIR STE B
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4884
Practice Address - Country:US
Practice Address - Phone:772-468-6800
Practice Address - Fax:772-464-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1956AD125700251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health