Provider Demographics
NPI:1508623166
Name:PARACLETE COUNSELING & CASE MANAGEMENT OF FLORIDA LLC
Entity Type:Organization
Organization Name:PARACLETE COUNSELING & CASE MANAGEMENT OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FABRAY
Authorized Official - Middle Name:DEALOW
Authorized Official - Last Name:SMITH-WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-209-0619
Mailing Address - Street 1:3200 NW LAKE JEFFERY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4773
Mailing Address - Country:US
Mailing Address - Phone:386-209-0619
Mailing Address - Fax:
Practice Address - Street 1:124 NW MADISON ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3922
Practice Address - Country:US
Practice Address - Phone:386-209-0619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty