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General NPI Number Information
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NPI Number | 1124388202
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Entity Type | Organization
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Legal Business Name | NEW COVENANT COUNSELING AND GUIDANCE CENTER, INC.
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 2210 S RIO GRANDE AVE
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City | ORLANDO
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State | FL
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Zip | 32805-5262
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Country | US
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Telephone | 321-438-4075
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Fax |
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Provider Business Mailing Address
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Address Line | 6820 NAWADAHA BLVD
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City | ORLANDO
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State | FL
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Zip | 32818-5365
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Country | US
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Telephone | 321-438-4075
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LERNARD WILSON
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Credential | LMHC, NCC
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Telephone | 321-438-4075
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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 | MH7412
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License Number State | FL
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