Organization
IMMERSION RECOVERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN WILLIAM (ADMINISTRATOR)
(561) 863-5904
Entity
Organization
Contact information
Practice address
1700 W WOOLBRIGHT RD STE 4, BOYNTON BEACH, FL 33426-6346
(561) 843-5904
Mailing address
1700 W WOOLBRIGHT RD STE 4, BOYNTON BEACH, FL 33426-6346
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
Other
Enumeration date
03/29/2016
Last updated
03/29/2016
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