Provider Demographics
NPI:1033467600
Name:THE MULTICULTURAL ADDICTION SERVICES, LLC
Entity type:Organization
Organization Name:THE MULTICULTURAL ADDICTION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:LICIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:CAP, ICADC
Authorized Official - Phone:407-369-9482
Mailing Address - Street 1:750 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:220
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3118
Mailing Address - Country:US
Mailing Address - Phone:407-369-9482
Mailing Address - Fax:407-385-8140
Practice Address - Street 1:750 S ORANGE BLOSSOM TRL
Practice Address - Street 2:220
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3118
Practice Address - Country:US
Practice Address - Phone:407-369-9482
Practice Address - Fax:407-385-8140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0948AD803001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health