Healthcare Provider Details

I. General information

NPI: 1851327514
Provider Name (Legal Business Name): COUNSELING & DEVELOPMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MAUD ST
TAVARES FL
32778-3249
US

IV. Provider business mailing address

101 E MAUD ST
TAVARES FL
32778-3249
US

V. Phone/Fax

Practice location:
  • Phone: 352-253-9348
  • Fax: 352-253-9351
Mailing address:
  • Phone: 352-253-9348
  • Fax: 352-253-9351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberSS690
License Number StateFL

VIII. Authorized Official

Name: DR. PATRICK J WARD
Title or Position: OWNER
Credential: PHD
Phone: 352-253-9348