Healthcare Provider Details

I. General information

NPI: 1023140381
Provider Name (Legal Business Name): FAMILY COUNSELING ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 MILITARY TRAIL SUITE 203
JUPITER FL
33458-4817
US

IV. Provider business mailing address

4425 MILITARY TRAIL STE 203
JUPITER FL
33458-4817
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-2775
  • Fax: 561-747-1881
Mailing address:
  • Phone: 561-747-2775
  • Fax: 561-747-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4347
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4786
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 4901
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 5367
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 6254
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5740
License Number StateFL

VIII. Authorized Official

Name: MS. GAIL DIANE GUILLORY
Title or Position: PRESIDENT
Credential: LCSW
Phone: 561-747-2775