Provider Demographics
NPI:1659808038
Name:CENTER FOR CHILD COUNSELING
Entity Type:Organization
Organization Name:CENTER FOR CHILD COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:561-779-7318
Mailing Address - Street 1:2234 LAKE WORTH RD
Mailing Address - Street 2:APT. 103
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461
Mailing Address - Country:US
Mailing Address - Phone:561-779-7318
Mailing Address - Fax:
Practice Address - Street 1:2234 LAKE WORTH RD
Practice Address - Street 2:APT. 103
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3256
Practice Address - Country:US
Practice Address - Phone:561-779-7318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH14691251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health