Healthcare Provider Details

I. General information

NPI: 1720397185
Provider Name (Legal Business Name): ST. LUKES UNITED METHODIST CHURCH, THE COMMUNITY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 S APOPKA-VINELAND RD.
ORLANDO FL
32819
US

IV. Provider business mailing address

4851 S APOPKA-VINELAND RD.
ORLANDO FL
32819
US

V. Phone/Fax

Practice location:
  • Phone: 407-876-4991
  • Fax: 407-876-5273
Mailing address:
  • Phone: 407-876-4991
  • Fax: 407-876-5273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH3582
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMH3582
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3582
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH3582
License Number StateFL

VIII. Authorized Official

Name: DR. JOANNE CHRISTINE MACPHERSON
Title or Position: DIRECTOR, THE COMMUNITY COUNSELING
Credential: L.M.H.C.
Phone: 407-876-4991