=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194098426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSIGHTS COUNSELING CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2012
-----------------------------------------------------
Last Update Date | 02/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2425 S VOLUSIA AVE SUITE B2
-----------------------------------------------------
City | ORANGE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32763-7625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-848-5170
-----------------------------------------------------
Fax | 386-740-8251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2425 S VOLUSIA AVE SUITE B2
-----------------------------------------------------
City | ORANGE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32763-7625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-848-5170
-----------------------------------------------------
Fax | 386-740-8251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | KARIN C WEIRI-KOLLE
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 386-848-5170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------