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General NPI Number Information
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NPI Number | 1750771622
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Entity Type | Organization
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Legal Business Name | EMBRIDGE COUNSELING SERVICES
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 140 S BEACH ST STE 310
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4409
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Country | US
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Telephone | 386-747-6541
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Fax | 866-401-6150
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Provider Business Mailing Address
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Address Line | 508 CORAL TRACE BLVD
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City | EDGEWATER
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State | FL
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Zip | 32132-6926
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Country | US
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Telephone | 386-747-6541
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Fax | 866-401-6150
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Authorized Official
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Title or Position | CEO
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Name | DR. EMEKA OBI ANYIAM
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Credential | LMFT
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Telephone | 386-747-6541
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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 | 2442
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License Number State | FL
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