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Organization

BACK NINE VENTURES CORP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHAD HARDWICK (AUTHORIZED OFFICIAL)
(813) 261-3171
Entity
Organization

Contact information

Practice address
6236 SCARLET DARTER WAY, TAMPA, FL 33625-3209
(813) 261-3171
Mailing address
6236 SCARLET DARTER WAY, TAMPA, FL 33625-3209
(813) 261-3171

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
07/17/2024
Last updated
07/17/2024
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