Provider Demographics
NPI:1689749160
Name:DELTONA COUNSELING ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:DELTONA COUNSELING ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:SHAMIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LMHC
Authorized Official - Phone:386-668-6989
Mailing Address - Street 1:2851 ENTERPRISE RD
Mailing Address - Street 2:SUITE 102-B
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2786
Mailing Address - Country:US
Mailing Address - Phone:386-668-6989
Mailing Address - Fax:386-668-6989
Practice Address - Street 1:2851 ENTERPRISE RD
Practice Address - Street 2:SUITE 102-B
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2786
Practice Address - Country:US
Practice Address - Phone:386-668-6989
Practice Address - Fax:386-668-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty