Provider Demographics
NPI:1669639530
Name:FAMILY GUIDANCE AND COUNSELING CENTER OF CENTRAL FLORIDA LLC
Entity Type:Organization
Organization Name:FAMILY GUIDANCE AND COUNSELING CENTER OF CENTRAL FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:HERTENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:386-490-5745
Mailing Address - Street 1:107 BRANDIWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2242
Mailing Address - Country:US
Mailing Address - Phone:386-490-5745
Mailing Address - Fax:386-788-3600
Practice Address - Street 1:3256 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 1100
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:407-416-5611
Practice Address - Fax:386-788-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW2941101Y00000X, 101YA0400X, 101YM0800X, 101YP1600X, 101YP2500X, 102L00000X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK122Medicare PIN