Provider Demographics
NPI:1093854192
Name:INTERNATIONAL ACADEMY OF CULTURAL FREE COUNSELING AND PSYCHOTHERAPY
Entity Type:Organization
Organization Name:INTERNATIONAL ACADEMY OF CULTURAL FREE COUNSELING AND PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CARNELL
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-269-4481
Mailing Address - Street 1:2457 SOUTHERN LINKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003
Mailing Address - Country:US
Mailing Address - Phone:904-269-4481
Mailing Address - Fax:904-269-4481
Practice Address - Street 1:2457 SOUTHERN LINKS DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-6356
Practice Address - Country:US
Practice Address - Phone:904-269-4481
Practice Address - Fax:904-269-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0054251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health