Provider Demographics
NPI:1679044242
Name:COUNSELING ASSOCIATES OF LAKE MARY, INC
Entity Type:Organization
Organization Name:COUNSELING ASSOCIATES OF LAKE MARY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-810-0984
Mailing Address - Street 1:8267 DAY LILY PL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-8129
Mailing Address - Country:US
Mailing Address - Phone:407-810-0984
Mailing Address - Fax:844-617-1549
Practice Address - Street 1:3300 W LAKE MARY BLVD STE 340
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3405
Practice Address - Country:US
Practice Address - Phone:304-609-2256
Practice Address - Fax:321-926-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty