Individual
MAXINE ROSE THALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3672 NW ADRIATIC LN BLDG 4, JENSEN BEACH, FL 34957-3111
(855) 299-4472
Mailing address
3672 NW ADRIATIC LN BLDG 4, JENSEN BEACH, FL 34957-3111
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
MH26923
FL
Other
Enumeration date
02/09/2026
Last updated
02/09/2026
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