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General NPI Number Information
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NPI Number | 1780059865
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Entity Type | Organization
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Legal Business Name | FOUR SEASONS COUNSELING,LLC
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 2933 MADISON ST
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City | MARIANNA
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State | FL
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Zip | 32446-3451
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Country | US
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Telephone | 850-557-7975
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Fax |
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Provider Business Mailing Address
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Address Line | 2933 MADISON ST
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City | MARIANNA
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State | FL
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Zip | 32446-3451
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Country | US
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Telephone | 850-557-7975
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. SHARON L MILLER.
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Credential | PH.D.
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Telephone | 850-557-7975
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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 | MH13813
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License Number State | FL
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