Provider Demographics
NPI:1578866562
Name:ADVANCED COUNSELING SERVICES, PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:ADVANCED COUNSELING SERVICES, PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREINER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:352-364-0067
Mailing Address - Street 1:1188 S BROAD ST
Mailing Address - Street 2:STE. 400
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3110
Mailing Address - Country:US
Mailing Address - Phone:352-364-0067
Mailing Address - Fax:352-364-0116
Practice Address - Street 1:1188 S BROAD ST
Practice Address - Street 2:STE. 400
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3110
Practice Address - Country:US
Practice Address - Phone:352-364-0067
Practice Address - Fax:352-364-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW9047251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ02HKOtherBLUE CROSS / BLUE SHIELD
FLZ02HKOtherBLUE CROSS / BLUE SHIELD