Provider Demographics
NPI:1922758804
Name:NORTH FLORIDA BEHAVIORAL CONSULTANTS LLC
Entity Type:Organization
Organization Name:NORTH FLORIDA BEHAVIORAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BURDITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:BCBA
Authorized Official - Phone:904-252-0427
Mailing Address - Street 1:462 AQUATIC DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-3834
Mailing Address - Country:US
Mailing Address - Phone:904-252-0427
Mailing Address - Fax:
Practice Address - Street 1:462 AQUATIC DR
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-3834
Practice Address - Country:US
Practice Address - Phone:904-252-0427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty