=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285899419
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADJUSTMENT AND AWARENESS COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2008
-----------------------------------------------------
Last Update Date | 07/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 243 3RD ST NW
-----------------------------------------------------
City | WINTER HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-291-3155
-----------------------------------------------------
Fax | 863-291-3274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 243 3RD ST NW
-----------------------------------------------------
City | WINTER HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-291-3155
-----------------------------------------------------
Fax | 863-291-3274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PAUL HARRIS SANDMAN8632913155
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 863-291-3155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 0002829
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------