Provider Demographics
NPI:1255938874
Name:STONEBRAKERS FLORIDA INC
Entity type:Organization
Organization Name:STONEBRAKERS FLORIDA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:STONEBRAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-575-5075
Mailing Address - Street 1:8210 WILLOW PT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-7939
Mailing Address - Country:US
Mailing Address - Phone:813-575-5075
Mailing Address - Fax:
Practice Address - Street 1:13944 LYNMAR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3123
Practice Address - Country:US
Practice Address - Phone:813-575-5075
Practice Address - Fax:813-640-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty