Organization
COACHING 4 KIDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY R RUSSELL LCSW (OWNER)
(727) 341-1000
Entity
Organization
Contact information
Practice address
6737 1ST AVE S, ST PETERSBURG, FL 33707-1307
(727) 341-1000
(727) 341-1000
Mailing address
6739 1ST AVE S, ST PETERSBURG, FL 33707-1307
(727) 341-1000
(727) 341-1000
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
SW6791
FL
Other
Enumeration date
02/22/2012
Last updated
02/22/2012
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