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General NPI Number Information
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NPI Number | 1306670237
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Entity Type | Organization
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Legal Business Name | FRESH WIND COUNSELING CENTER LLC
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Dates
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Enumeration Date | 09/02/2024
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Last Update Date | 09/02/2024
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Provider Practice Location Address
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Address Line | 2509 BARRINGTON CIR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-6800
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Country | US
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Telephone | 850-845-8448
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Fax | 877-940-2611
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Provider Business Mailing Address
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Address Line | 1563 CAPITAL CIR SE # 376
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City | TALLAHASSEE
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State | FL
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Zip | 32301-5115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JIMMEAL PETERSON
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Credential | LCWS
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Telephone | 850-745-2322
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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 |
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License Number State |
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