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General NPI Number Information
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NPI Number | 1639624588
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE COUNSELING
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 310 E MAIN ST
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City | AVON PARK
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State | FL
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Zip | 33825-3216
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Country | US
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Telephone | 321-525-1556
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Fax |
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Provider Business Mailing Address
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Address Line | 310 E MAIN ST
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City | AVON PARK
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State | FL
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Zip | 33825-3216
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Country | US
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Telephone | 321-525-1556
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. NAWAL SAJIH ABOULHOSN
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Credential | PHD
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Telephone | 321-525-1556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH 7623
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CAP 5229
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MT 2810
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License Number State | FL
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