Provider Demographics
NPI:1568073195
Name:SOUTH LAKE FAMILY COUNSELING SERVICES
Entity Type:Organization
Organization Name:SOUTH LAKE FAMILY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:352-359-2073
Mailing Address - Street 1:12946 COLONNADE CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6611
Mailing Address - Country:US
Mailing Address - Phone:352-359-2073
Mailing Address - Fax:
Practice Address - Street 1:12946 COLONNADE CIR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6611
Practice Address - Country:US
Practice Address - Phone:352-359-2073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty