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General NPI Number Information
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NPI Number | 1265631790
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Entity Type | Organization
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Legal Business Name | AWARENESS COUNSELING CENTER OF THE INDIAN RIVER INC
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Dates
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Enumeration Date | 07/14/2007
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 7766 BAY ST #11
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City | SEBASTIAN
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State | FL
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Zip | 32958-3427
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Country | US
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Telephone | 772-589-7008
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Fax | 772-589-7008
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Provider Business Mailing Address
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Address Line | 13537 US HIGHWAY 1 #137
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City | SEBASTIAN
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State | FL
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Zip | 32958-3760
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Country | US
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Telephone | 772-589-7008
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Fax | 772-589-7008
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. GANGA MAYEE JOYCE WASSERMAN
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Credential | LCSW
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Telephone | 772-589-7008
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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 | SW6348
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License Number State | FL
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