Provider Demographics
NPI:1043304918
Name:COMMUNITY CHRISTIAN COUNSELING CENTER
Entity Type:Organization
Organization Name:COMMUNITY CHRISTIAN COUNSELING CENTER
Other - Org Name:COMMUNITY CHRISTAN COUNSELING CENTER OF PALM BEACH COUNTY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:LARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:D MIN
Authorized Official - Phone:561-622-5423
Mailing Address - Street 1:9625 NORTH MILITARY TRAIL
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-622-5423
Mailing Address - Fax:561-622-5467
Practice Address - Street 1:9625 NORTH MILITARY TRAIL
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-622-5423
Practice Address - Fax:561-622-5467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7183101YM0800X
101YP1600X
FLMT 0903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty