Provider Demographics
NPI:1417352543
Name:COUNSELING SOLUTIONS OF NORTHEAST FLORIDA INC
Entity Type:Organization
Organization Name:COUNSELING SOLUTIONS OF NORTHEAST FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITTINGHAM
Authorized Official - Suffix:SR
Authorized Official - Credentials:CAMSII, BS
Authorized Official - Phone:863-692-6802
Mailing Address - Street 1:9951 ATLANTIC BLVD STE 174
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6592
Mailing Address - Country:US
Mailing Address - Phone:863-692-6802
Mailing Address - Fax:800-878-0637
Practice Address - Street 1:9951 ATLANTIC BLVD STE 174
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6592
Practice Address - Country:US
Practice Address - Phone:863-692-6802
Practice Address - Fax:800-878-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty