Provider Demographics
NPI:1639472939
Name:BRADENTON COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:BRADENTON COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:941-792-0802
Mailing Address - Street 1:5131 MANATEE AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3740
Mailing Address - Country:US
Mailing Address - Phone:941-792-0802
Mailing Address - Fax:941-795-2102
Practice Address - Street 1:5131 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3740
Practice Address - Country:US
Practice Address - Phone:941-792-0802
Practice Address - Fax:941-795-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW20981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty