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General NPI Number Information
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NPI Number | 1447345574
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Entity Type | Organization
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Legal Business Name | COUNSELING AND RECOVERY CENTER, INC.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4753 ORANGE AVE
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City | FORT PIERCE
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State | FL
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Zip | 34947-3410
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Country | US
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Telephone | 772-467-3057
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Fax | 772-467-3059
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Provider Business Mailing Address
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Address Line | 4753 ORANGE AVE
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City | FORT PIERCE
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State | FL
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Zip | 34947-3410
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Country | US
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Telephone | 772-467-3057
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Fax | 772-467-3059
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JILL MARIE ARNOLD
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Credential | LMHC
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Telephone | 772-467-3057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1556AD805100
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License Number State | FL
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