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General NPI Number Information
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NPI Number | 1962697441
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Entity Type | Organization
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Legal Business Name | SANTA ROSA COUNSELING CENTER LLC
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 5642 JONES ST
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City | MILTON
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State | FL
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Zip | 32570-2304
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Country | US
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Telephone | 850-626-7779
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Fax | 850-626-7171
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Provider Business Mailing Address
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Address Line | 5642 JONES ST
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City | MILTON
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State | FL
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Zip | 32570-2304
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Country | US
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Telephone | 850-626-7779
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Fax | 850-626-7171
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Authorized Official
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Title or Position | SENIOR PARTNER
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Name | KAREN ALESIA WILLIS
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Credential | LMFT, LMHC
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Telephone | 850-626-7779
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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 | MH8971
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT2297
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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 |
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License Number State |
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