Provider Demographics
NPI:1043411044
Name:CHRISTIAN CARE COUNSELING CENTER
Entity Type:Organization
Organization Name:CHRISTIAN CARE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:AMESTY
Authorized Official - Suffix:
Authorized Official - Credentials:CHRISTIAN COUNSELOR
Authorized Official - Phone:407-290-1609
Mailing Address - Street 1:3401 LAKE BREEZE DR STE 601-A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-3011
Mailing Address - Country:US
Mailing Address - Phone:407-290-1609
Mailing Address - Fax:
Practice Address - Street 1:3401 LAKE BREEZE DR STE 601-A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-3011
Practice Address - Country:US
Practice Address - Phone:407-290-1609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCCC4613251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based