Provider Demographics
NPI:1033588447
Name:CHRISTIAN COUNSELING CENTER
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYLON
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PSYCHOLOGIST
Authorized Official - Phone:813-763-5978
Mailing Address - Street 1:13309 WALDEN SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:FL
Mailing Address - Zip Code:33527-5547
Mailing Address - Country:US
Mailing Address - Phone:813-763-5978
Mailing Address - Fax:
Practice Address - Street 1:13309 WALDEN SHEFFIELD RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:FL
Practice Address - Zip Code:33527-5547
Practice Address - Country:US
Practice Address - Phone:813-763-5978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCPY0011301094 FACCT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health