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General NPI Number Information
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NPI Number | 1043411044
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Entity Type | Organization
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Legal Business Name | CHRISTIAN CARE COUNSELING CENTER
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3401 LAKE BREEZE DR STE 601-A
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City | ORLANDO
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State | FL
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Zip | 32808-3011
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Country | US
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Telephone | 407-290-1609
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 LAKE BREEZE DR STE 601-A
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City | ORLANDO
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State | FL
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Zip | 32808-3011
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Country | US
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Telephone | 407-290-1609
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | DR. JUAN C AMESTY
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Credential | CHRISTIAN COUNSELOR
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Telephone | 407-290-1609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | LCCC4613
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License Number State | FL
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