Healthcare Provider Details

I. General information

NPI: 1851439434
Provider Name (Legal Business Name): AMERICAN FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 W MCNAB RD SUITE 120
FT LAUDERDALE FL
33309-1115
US

IV. Provider business mailing address

970 W MCNAB RD SUITE 120
FT LAUDERDALE FL
33309-1115
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-7696
  • Fax: 954-977-3985
Mailing address:
  • Phone: 954-772-7696
  • Fax: 954-977-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number438
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4097
License Number StateFL

VIII. Authorized Official

Name: MR. LAWRENCE JOSEPH GALLICHIO
Title or Position: EXECUTIVE DIRECTOR
Credential: LMCH,CAP
Phone: 954-772-7696