Provider Demographics
NPI:1982227070
Name:CLINICIANS OF SOUTH DADE LLC
Entity Type:Organization
Organization Name:CLINICIANS OF SOUTH DADE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DASHUN
Authorized Official - Middle Name:TYRELL
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-672-5005
Mailing Address - Street 1:525 N TRYON ST STE 1609
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-0202
Mailing Address - Country:US
Mailing Address - Phone:919-672-5005
Mailing Address - Fax:
Practice Address - Street 1:333 SE 2ND AVE STE 2000
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2185
Practice Address - Country:US
Practice Address - Phone:919-672-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty