Provider Demographics
NPI:1760765838
Name:AGAPE FAMILY EDUCATION PROJECT AND COUNSELING PROGRAM INC.
Entity Type:Organization
Organization Name:AGAPE FAMILY EDUCATION PROJECT AND COUNSELING PROGRAM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:YOWANDA
Authorized Official - Last Name:HERRING-COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, CFLE
Authorized Official - Phone:904-416-4121
Mailing Address - Street 1:1372 LANE AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-6885
Mailing Address - Country:US
Mailing Address - Phone:904-416-4121
Mailing Address - Fax:904-781-9182
Practice Address - Street 1:1372 LANE AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6885
Practice Address - Country:US
Practice Address - Phone:904-416-4121
Practice Address - Fax:904-781-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-24
Last Update Date:2013-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251300000X, 251B00000X, 251E00000X, 251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMT1711OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE
FLCFLEOtherNATIONALCOUNCIL ON FAMILY RELATIONS