Provider Demographics
NPI:1811124613
Name:TRCFL LLC
Entity type:Organization
Organization Name:TRCFL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, DCSW, SAP
Authorized Official - Phone:850-656-5112
Mailing Address - Street 1:2724 CAPITAL CIR NE STE 8
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1119
Mailing Address - Country:US
Mailing Address - Phone:850-656-5112
Mailing Address - Fax:850-656-3802
Practice Address - Street 1:2898 MAHAN DR STE 6
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5462
Practice Address - Country:US
Practice Address - Phone:850-656-5112
Practice Address - Fax:850-656-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 4326101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7478Medicare PIN
FL1811924509Medicare UPIN