Healthcare Provider Details

I. General information

NPI: 1962669358
Provider Name (Legal Business Name): MERIDIAN COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38108 MERIDIAN AVE
DADE CITY FL
33525-3838
US

IV. Provider business mailing address

PO BOX 337
DADE CITY FL
33526-0337
US

V. Phone/Fax

Practice location:
  • Phone: 352-518-5232
  • Fax:
Mailing address:
  • Phone: 352-518-5232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7563
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT1605
License Number StateFL

VIII. Authorized Official

Name: GLORIA L PAYNE
Title or Position: OWNER/COUNSELOR
Credential: PHD, LMFT
Phone: 352-518-5232