Provider Demographics
NPI:1710134721
Name:STONE RIDGE COUNSELING CENTER INC
Entity Type:Organization
Organization Name:STONE RIDGE COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-478-7800
Mailing Address - Street 1:9013 UNIVERSITY PARKWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-9416
Mailing Address - Country:US
Mailing Address - Phone:850-478-7800
Mailing Address - Fax:850-478-7802
Practice Address - Street 1:9013 UNIVERSITY PARKWAY
Practice Address - Street 2:SUITE C
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-9416
Practice Address - Country:US
Practice Address - Phone:850-478-7800
Practice Address - Fax:850-478-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4384101YM0800X
FLMH1920101YM0800X
FLSW35951041C0700X
FLSW30771041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty