Provider Demographics
NPI:1538462478
Name:CENTER FOR COUNSELING & CONSULTING, INC.
Entity Type:Organization
Organization Name:CENTER FOR COUNSELING & CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:BOLLET
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:407-678-6655
Mailing Address - Street 1:661 SEMINOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3057
Mailing Address - Country:US
Mailing Address - Phone:407-678-6655
Mailing Address - Fax:407-696-7999
Practice Address - Street 1:661 SEMINOLA BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3057
Practice Address - Country:US
Practice Address - Phone:407-678-6655
Practice Address - Fax:407-696-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75240Medicare PIN