Provider Demographics
NPI:1932140126
Name:U.S. DEPARTMENT OF VETERANS AFFAIRS ORLANDO VA HEALTHCARE CENTER
Entity type:Organization
Organization Name:U.S. DEPARTMENT OF VETERANS AFFAIRS ORLANDO VA HEALTHCARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORK
Authorized Official - Prefix:MR
Authorized Official - First Name:DORNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-599-1472
Mailing Address - Street 1:2001 GLENRIDGE WAY
Mailing Address - Street 2:APARTMENT #48
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792
Mailing Address - Country:US
Mailing Address - Phone:407-629-6360
Mailing Address - Fax:407-599-1472
Practice Address - Street 1:5201 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:407-599-1472
Practice Address - Fax:407-599-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-00571101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty