Provider Demographics
NPI:1265631790
Name:AWARENESS COUNSELING CENTER OF THE INDIAN RIVER INC
Entity Type:Organization
Organization Name:AWARENESS COUNSELING CENTER OF THE INDIAN RIVER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GANGA MAYEE
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:772-589-7008
Mailing Address - Street 1:13537 US HIGHWAY 1
Mailing Address - Street 2:#137
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3760
Mailing Address - Country:US
Mailing Address - Phone:772-589-7008
Mailing Address - Fax:772-589-7008
Practice Address - Street 1:7766 BAY ST
Practice Address - Street 2:#11
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3427
Practice Address - Country:US
Practice Address - Phone:772-589-7008
Practice Address - Fax:772-589-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW63481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9500OtherPROVIDER NUMBER