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General NPI Number Information
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NPI Number | 1245602226
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Entity Type | Organization
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Legal Business Name | PREMIER COUNSELING & FAMILY THERAPY INC
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 200 KNUTH RD SUITE 238B
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4629
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Country | US
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Telephone | 561-336-6401
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Fax | 561-892-0902
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Provider Business Mailing Address
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Address Line | 200 KNUTH RD SUITE 238B
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4629
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Country | US
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Telephone | 561-336-6401
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Fax | 561-892-0902
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Authorized Official
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Title or Position | CEO
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Name | MS. CARLINE CHARLES
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Credential | MSW
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Telephone | 561-860-2588
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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 | ISW6139
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License Number State | FL
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