Provider Demographics
NPI:1639624588
Name:SUPPORTIVE COUNSELING
Entity Type:Organization
Organization Name:SUPPORTIVE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAWAL
Authorized Official - Middle Name:SAJIH
Authorized Official - Last Name:ABOULHOSN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-525-1556
Mailing Address - Street 1:310 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-3216
Mailing Address - Country:US
Mailing Address - Phone:321-525-1556
Mailing Address - Fax:
Practice Address - Street 1:310 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-3216
Practice Address - Country:US
Practice Address - Phone:321-525-1556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2810251S00000X
FLMH 7623251S00000X
FLCAP 5229251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health