Provider Demographics
NPI:1023186160
Name:APALACHEE CENTER, INC.
Entity Type:Organization
Organization Name:APALACHEE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-523-3289
Mailing Address - Street 1:275 JOHN KNOX RD
Mailing Address - Street 2:APARTMENT L-103
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6614
Mailing Address - Country:US
Mailing Address - Phone:850-383-9876
Mailing Address - Fax:
Practice Address - Street 1:225 SUMATRA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-1435
Practice Address - Country:US
Practice Address - Phone:850-973-5124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 8374251S00000X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered273R00000XHospital UnitsPsychiatric Unit