Provider Demographics
NPI:1295009413
Name:ANCHORAGE COUNSELING SERVICE, INC
Entity Type:Organization
Organization Name:ANCHORAGE COUNSELING SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:MILLELOT
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LMCH
Authorized Official - Phone:850-433-2042
Mailing Address - Street 1:178 KEVIN DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4378
Mailing Address - Country:US
Mailing Address - Phone:850-291-9293
Mailing Address - Fax:850-607-6935
Practice Address - Street 1:7100 PLANTATION RD STE 11
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6234
Practice Address - Country:US
Practice Address - Phone:850-433-2042
Practice Address - Fax:850-607-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1369251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health