Healthcare Provider Details

I. General information

NPI: 1124324934
Provider Name (Legal Business Name): FIRST COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 BRUTON BLVD SUITE A
ORLANDO FL
32805
US

IV. Provider business mailing address

3125 BRUTON BLVD SUITE A
ORLANDO FL
32805
US

V. Phone/Fax

Practice location:
  • Phone: 407-514-4470
  • Fax:
Mailing address:
  • Phone: 407-514-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5041
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. KARI BOZARD RUSSO
Title or Position: DIRECTOR /LICENSED MENTAL HEALTH
Credential: LMHC
Phone: 407-514-4470