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General NPI Number Information
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NPI Number | 1043304918
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Entity Type | Organization
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Legal Business Name | COMMUNITY CHRISTIAN COUNSELING CENTER
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 9625 NORTH MILITARY TRAIL
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410
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Country | US
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Telephone | 561-622-5423
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Fax | 561-622-5467
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Provider Business Mailing Address
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Address Line | 9625 NORTH MILITARY TRAIL
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410
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Country | US
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Telephone | 561-622-5423
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Fax | 561-622-5467
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. WILLIAM G LARRISON
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Credential | D. MIN.
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Telephone | 561-622-5423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 0903
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 7183
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License Number State | FL
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