Provider Demographics
NPI:1720397185
Name:ST. LUKES UNITED METHODIST CHURCH, THE COMMUNITY COUNSELING CENTER
Entity Type:Organization
Organization Name:ST. LUKES UNITED METHODIST CHURCH, THE COMMUNITY COUNSELING CENTER
Other - Org Name:THE COMMUNITY COUNSELING CENTER AT ST. LUKES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, THE COMMUNITY COUNSELING
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:MACPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-876-4991
Mailing Address - Street 1:4851 S APOPKA-VINELAND RD.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819
Mailing Address - Country:US
Mailing Address - Phone:407-876-4991
Mailing Address - Fax:407-876-5273
Practice Address - Street 1:4851 S APOPKA-VINELAND RD.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-876-4991
Practice Address - Fax:407-876-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3582101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty