Organization
PROFESSIONAL TRAINING ASSOCIATION CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITCHELL E. WALLICK (EXECUTIVE DIRECTOR)
(561) 494-0866
Entity
Organization
Contact information
Practice address
321 NORTHLAKE BLVD, #102, NORTH PALM BAECH, FL 33408
(561) 494-0866
(561) 494-0984
Mailing address
321 NORTHLAKE BLVD, SUITE 102, NORTH PALM BEACH, FL 33408-5422
(561) 494-0866
(561) 494-0984
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
FL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
1550AD384701
FL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
0950AD384702
FL
Other
Enumeration date
02/13/2007
Last updated
02/11/2014
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