Provider Demographics
NPI:1780860262
Name:PENSACOLA BAY BAPTIST ASSOCIAITON
Entity Type:Organization
Organization Name:PENSACOLA BAY BAPTIST ASSOCIAITON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:CROLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-471-3430
Mailing Address - Street 1:9999 CHEMSTRAND RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-2724
Mailing Address - Country:US
Mailing Address - Phone:850-471-3430
Mailing Address - Fax:
Practice Address - Street 1:9999 CHEMSTRAND RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-2724
Practice Address - Country:US
Practice Address - Phone:850-471-3430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6156251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health