Provider Demographics
NPI:1952781643
Name:FAMILY CONNECTIONSOUTPATIENT
Entity Type:Organization
Organization Name:FAMILY CONNECTIONSOUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-530-7645
Mailing Address - Street 1:303 SONOMA VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5141
Mailing Address - Country:US
Mailing Address - Phone:252-412-8379
Mailing Address - Fax:
Practice Address - Street 1:303 SONOMA VALLEY CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5141
Practice Address - Country:US
Practice Address - Phone:252-412-8379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123999OtherSTATE