Healthcare Provider Details

I. General information

NPI: 1477032548
Provider Name (Legal Business Name): FAMILY HEALTH COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 FOREST HILL BLVD STE 102
PALM SPRINGS FL
33406-5941
US

IV. Provider business mailing address

2677 FOREST HILL BLVD STE 102
PALM SPRINGS FL
33406-5941
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-0123
  • Fax: 561-967-3484
Mailing address:
  • Phone: 561-433-0123
  • Fax: 561-967-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: LAURENCIO LIRA
Title or Position: COMMUNITY COORDINATOR
Credential: CDC
Phone: 561-420-3012