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General NPI Number Information
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NPI Number | 1962669358
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Entity Type | Organization
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Legal Business Name | MERIDIAN COUNSELING CENTER, INC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 38108 MERIDIAN AVE
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City | DADE CITY
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State | FL
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Zip | 33525-3838
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Country | US
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Telephone | 352-518-5232
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 337
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City | DADE CITY
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State | FL
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Zip | 33526-0337
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Country | US
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Telephone | 352-518-5232
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | GLORIA L PAYNE
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Credential | PHD, LMFT
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Telephone | 352-518-5232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1605
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH7563
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License Number State | FL
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