Provider Demographics
NPI:1376939835
Name:THE DOOR CHRISTIAN COUNSELING, LLC
Entity Type:Organization
Organization Name:THE DOOR CHRISTIAN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RAEFORD
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:321-543-3898
Mailing Address - Street 1:137 S COURTENAY PKWY # 582
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4843
Mailing Address - Country:US
Mailing Address - Phone:321-749-3589
Mailing Address - Fax:
Practice Address - Street 1:1000 N BANANA RIVER DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952
Practice Address - Country:US
Practice Address - Phone:321-749-3589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-11
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty