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General NPI Number Information
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NPI Number | 1669639530
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Entity Type | Organization
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Legal Business Name | FAMILY GUIDANCE AND COUNSELING CENTER OF CENTRAL FLORIDA LLC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 3256 W LAKE MARY BLVD SUITE 1100
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City | LAKE MARY
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State | FL
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Zip | 32746
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Country | US
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Telephone | 407-416-5611
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Fax | 386-788-3600
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Provider Business Mailing Address
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Address Line | 107 BRANDIWOOD CT
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City | DEBARY
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State | FL
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Zip | 32713-2242
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Country | US
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Telephone | 386-490-5745
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Fax | 386-788-3600
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Authorized Official
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Title or Position | SOLE MBR
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Name | MR. CARL CHRISTIAN HERTENSTEIN
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Credential | LCSW
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Telephone | 386-490-5745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | SW2941
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SW2941
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SW2941
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | SW2941
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | SW2941
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | SW2941
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | SW2941
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License Number State | FL
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Taxonomy #8
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW2941
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License Number State | FL
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