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General NPI Number Information
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NPI Number | 1073744587
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Entity Type | Organization
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Legal Business Name | THE SOUTHERN INSTITUTE FOR FAMILY & COMMUNITY PRESERVATION, INC.
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 3841 KILLEARN CT SUITE A
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City | TALLAHASSEE
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State | FL
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Zip | 32309-3466
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Country | US
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Telephone | 850-443-1334
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13964
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City | TALLAHASSEE
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State | FL
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Zip | 32317-3964
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Country | US
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Telephone | 850-443-1334
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Fax | 850-894-0903
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Authorized Official
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Title or Position | CEO/ LICENSED MENTAL HEALTH COUNSEL
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Name | MRS. D. AMELIA B KEMP
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Credential | M.S., LMHC
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Telephone | 850-443-1334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH-5565
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License Number State | FL
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