Healthcare Provider Details

I. General information

NPI: 1265156459
Provider Name (Legal Business Name): CROSSPOINT UNITED METHODIST CHURCH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MCKINNEY ST
NICEVILLE FL
32578-2534
US

IV. Provider business mailing address

214 PARTIN DR S
NICEVILLE FL
32578-2413
US

V. Phone/Fax

Practice location:
  • Phone: 850-279-4576
  • Fax: 850-505-3068
Mailing address:
  • Phone: 850-678-4411
  • Fax: 850-505-3068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. ALYSSA GAVULIC HOWK
Title or Position: DIRECTOR OF COUNSELING
Credential: LMFT, LMHC
Phone: 850-279-4576