Provider Demographics
NPI:1275692204
Name:PROGRESSIVE COUNSELING CENTERS INC
Entity Type:Organization
Organization Name:PROGRESSIVE COUNSELING CENTERS INC
Other - Org Name:BREVARD OUTPATIENT ALTERNATIVE TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLDSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:321-773-1111
Mailing Address - Street 1:1127 S PATRICK DR
Mailing Address - Street 2:SUITE 24
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3939
Mailing Address - Country:US
Mailing Address - Phone:321-773-1111
Mailing Address - Fax:321-773-1692
Practice Address - Street 1:1127 S PATRICK DR
Practice Address - Street 2:SUITE 24
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3939
Practice Address - Country:US
Practice Address - Phone:321-773-1111
Practice Address - Fax:321-773-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0705AD916901101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty