Provider Demographics
NPI:1083140586
Name:THE HAZEL COUNSELING CENTER FOR FAMILIES AND CHILDREN, PLLC
Entity Type:Organization
Organization Name:THE HAZEL COUNSELING CENTER FOR FAMILIES AND CHILDREN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-365-1199
Mailing Address - Street 1:2441 WSR 426
Mailing Address - Street 2:SUITE 1031
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4516
Mailing Address - Country:US
Mailing Address - Phone:407-365-1199
Mailing Address - Fax:407-365-1177
Practice Address - Street 1:2441 WSR 426
Practice Address - Street 2:SUITE 1031
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4516
Practice Address - Country:US
Practice Address - Phone:407-365-1199
Practice Address - Fax:407-365-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8802101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty