Provider Demographics
NPI:1356548721
Name:CFSATC, INC.
Entity type:Organization
Organization Name:CFSATC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:2198 HARRIS AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4002
Mailing Address - Country:US
Mailing Address - Phone:321-951-9750
Mailing Address - Fax:321-951-9765
Practice Address - Street 1:2198 HARRIS AVE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4002
Practice Address - Country:US
Practice Address - Phone:321-951-9750
Practice Address - Fax:321-951-9765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0705AD119402251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL========= 01Medicaid