Provider Demographics
NPI:1578990784
Name:NORTH FLORIDA CENTER FOR COUNSELING, LLC
Entity Type:Organization
Organization Name:NORTH FLORIDA CENTER FOR COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAINSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:386-965-3577
Mailing Address - Street 1:1191 SW SHENANDOAH GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-0425
Mailing Address - Country:US
Mailing Address - Phone:386-965-3577
Mailing Address - Fax:
Practice Address - Street 1:260 SOUTH MARION AVENUE SUITE 140
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-965-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty