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General NPI Number Information
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NPI Number | 1376819599
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Entity Type | Organization
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Legal Business Name | FAMILY CARE COUNSELING
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 211 LIVE OAK ST
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7115
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Country | US
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Telephone | 386-427-2241
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Fax | 386-427-2242
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Provider Business Mailing Address
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Address Line | 211 LIVE OAK ST
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7115
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Country | US
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Telephone | 386-427-2241
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Fax | 386-427-2242
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORDON GERALD GREENHALGH
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Credential | PH.D
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Telephone | 386-427-2241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT0951
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License Number State | FL
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