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General NPI Number Information
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NPI Number | 1932637253
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Entity Type | Organization
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Legal Business Name | SHILOH COUNSELING CENTER
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 06/08/2019
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Provider Practice Location Address
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Address Line | 8490 LA SALLE DR
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City | MILTON
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State | FL
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Zip | 32583-2439
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Country | US
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Telephone | 850-516-1202
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Fax |
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Provider Business Mailing Address
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Address Line | 8490 LA SALLE DR
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City | MILTON
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State | FL
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Zip | 32583-2439
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Country | US
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Telephone | 850-516-1202
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY ANN LILLY WOOD
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Credential | M.S.W.
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Telephone | 850-516-1202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW10234
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License Number State | FL
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