Provider Demographics
NPI:1568712495
Name:HEALING BALM MINISTRIES OF NORTHEAST FLORIDA
Entity Type:Organization
Organization Name:HEALING BALM MINISTRIES OF NORTHEAST FLORIDA
Other - Org Name:FLORIDA COMMUNITY PREVENTION CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATRECE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CAPP, CPS CMHP
Authorized Official - Phone:904-321-4097
Mailing Address - Street 1:96098 VICTORIAS PL
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:96098 VICTORIAS PL
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-6349
Practice Address - Country:US
Practice Address - Phone:904-321-4097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLN01000001168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty