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General NPI Number Information
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NPI Number | 1114294824
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Entity Type | Organization
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Legal Business Name | FAMILY LIFE CHRISTIAN COUNSELING, INC.
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 2121 CORPORATE SQUARE BLVD. SUITE 251
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1992
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Country | US
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Telephone | 904-725-1800
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Fax | 904-725-6241
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Provider Business Mailing Address
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Address Line | 2121 CORPORATE SQUARE BLVD. SUITE 251
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1992
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Country | US
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Telephone | 904-725-1800
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Fax | 904-725-6241
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEITH RAYMOND SCHROYER
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Credential | LCSW
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Telephone | 904-725-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW4361
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License Number State | FL
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