Provider Demographics
NPI:1235561630
Name:FIRST COAST COUNSELING AND SUPPORT SERVICES
Entity Type:Organization
Organization Name:FIRST COAST COUNSELING AND SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PLPC, RMHI
Authorized Official - Phone:904-236-1599
Mailing Address - Street 1:49 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2816
Mailing Address - Country:US
Mailing Address - Phone:904-236-1599
Mailing Address - Fax:
Practice Address - Street 1:49 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-2816
Practice Address - Country:US
Practice Address - Phone:904-236-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management