Provider Demographics
NPI:1255675369
Name:ALACHUA ADULT, CHILD AND FAMILY GUIDANCE CENTER, INC
Entity Type:Organization
Organization Name:ALACHUA ADULT, CHILD AND FAMILY GUIDANCE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:352-338-0164
Mailing Address - Street 1:4140 NW 27TH LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7473
Mailing Address - Country:US
Mailing Address - Phone:352-338-0164
Mailing Address - Fax:352-338-0165
Practice Address - Street 1:4140 NW 27TH LN
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7473
Practice Address - Country:US
Practice Address - Phone:352-338-0164
Practice Address - Fax:352-338-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2118305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization