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General NPI Number Information
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NPI Number | 1629034996
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Entity Type | Organization
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Legal Business Name | ADULT & CHILD COUNSELING AND PSYCHIATRIC CENTER, P.A.
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 5545 N WICKHAM RD SUITE 110
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City | MELBOURNE
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State | FL
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Zip | 32940-7323
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Country | US
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Telephone | 321-779-9838
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Fax | 321-779-4502
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Provider Business Mailing Address
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Address Line | 5545 N WICKHAM RD SUITE 110
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City | MELBOURNE
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State | FL
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Zip | 32940-7323
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Country | US
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Telephone | 321-779-9838
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Fax | 321-779-4502
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Authorized Official
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Title or Position | CEO
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Name | DR. VIJAYKUMAR R BHUJANG
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Credential | M.D.
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Telephone | 321-779-9838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME40362
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW3652
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW3614
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME50534
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License Number State | FL
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