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General NPI Number Information
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NPI Number | 1659808038
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Entity Type | Organization
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Legal Business Name | CENTER FOR CHILD COUNSELING
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 05/17/2017
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Provider Practice Location Address
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Address Line | 2234 LAKE WORTH RD APT. 103
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City | LAKE WORTH
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State | FL
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Zip | 33461-3256
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Country | US
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Telephone | 561-779-7318
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Fax |
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Provider Business Mailing Address
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Address Line | 2234 LAKE WORTH RD APT. 103
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City | LAKE WORTH
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State | FL
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Zip | 33461
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Country | US
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Telephone | 561-779-7318
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Fax |
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Authorized Official
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Title or Position | CHILD AND FAMILY THERAPIST
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Name | ROSA M FERNANDEZ
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Credential | M.S.
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Telephone | 561-779-7318
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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 | IMH14691
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License Number State | FL
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