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General NPI Number Information
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NPI Number | 1093065435
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Entity Type | Organization
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Legal Business Name | FAMILY ENHANCEMENT & COUNSELING GROUP, LLC
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 500 5TH AVE S SUITE 202
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City | NAPLES
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State | FL
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Zip | 34102-6615
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Country | US
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Telephone | 239-262-0515
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Fax | 650-362-0515
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Provider Business Mailing Address
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Address Line | 500 5TH AVE S SUITE 202
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City | NAPLES
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State | FL
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Zip | 34102-6615
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Country | US
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Telephone | 239-262-0515
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MICHELLE LEE BANCROFT
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Credential |
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Telephone | 239-262-0515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT2329
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License Number State | FL
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