Organization
EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
Active
Organization
EASTERSEALS NORTHEAST CENTRAL FLORIDA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE WALLENS (ACCOUNTING MANAGER)
(386) 449-7805
Entity
Organization
Contact information
Practice address
3804 PIONEER TRL, NEW SMYRNA BEACH, FL 32168-8784
(386) 944-7805
(386) 258-7677
Mailing address
1219 DUNN AVE, DAYTONA BEACH, FL 32114-2405
(386) 944-7805
(386) 258-7677
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/22/2023
Last updated
11/08/2023
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