Healthcare Provider Details

I. General information

NPI: 1821456799
Provider Name (Legal Business Name): COUNSELING & REHABILITATION ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5024 NW 27TH CT SUITE B
GAINESVILLE FL
32606-6545
US

IV. Provider business mailing address

PO BOX 357996
GAINESVILLE FL
32635-7996
US

V. Phone/Fax

Practice location:
  • Phone: 352-378-2600
  • Fax: 352-378-1828
Mailing address:
  • Phone: 352-318-8780
  • Fax: 352-378-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH 854
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH 854
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT PRICE HOSFORD
Title or Position: OWNER
Credential: PH. D.
Phone: 352-318-8780