MEDICARE: POSITIVE CHANGE COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW8445	FL

General Provider Information

NPI Number	:	1770817512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE CHANGE COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	6645 VINELAND RD
Second Line	:	SUITE 250
City	:	ORLANDO
State	:	FL
Zip	:	32819-7841
Country	:	US
Telephone Number	:	407-230-6280
Fax Number	:

Provider Business Practice Location Address
First Line	:	6645 VINELAND RD
Second Line	:	SUITE 250
City	:	ORLANDO
State	:	FL
Zip	:	32819-7841
Country	:	US
Telephone Number	:	407-230-6280
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	KAREN FOLEY
Credential	:	LCSW
Telephone Number	:	407-230-6280

Provider Enumeration Date	:	09/27/2009
Last Update Date	:	09/27/2009

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