Healthcare Provider Details

I. General information

NPI: 1265915896
Provider Name (Legal Business Name): ALINA COMMUNITY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 NE JACKSONVILLE RD STE A
OCALA FL
34470-4141
US

IV. Provider business mailing address

1815 NE JACKSONVILLE RD STE A
OCALA FL
34470-4141
US

V. Phone/Fax

Practice location:
  • Phone: 305-767-0887
  • Fax:
Mailing address:
  • Phone: 305-767-0887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. GRAVIL JOSEPH
Title or Position: CEO
Credential: PMHNP-BC
Phone: 305-767-0887