Provider Demographics
NPI:1457109696
Name:SOMETHING MORE
Entity type:Organization
Organization Name:SOMETHING MORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LICHTENWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:765-376-8099
Mailing Address - Street 1:1910 MARILYN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-5123
Mailing Address - Country:US
Mailing Address - Phone:765-376-8099
Mailing Address - Fax:
Practice Address - Street 1:3930 S NOVA RD STE 307
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9293
Practice Address - Country:US
Practice Address - Phone:138-679-5799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)