Provider Demographics
NPI:1790350502
Name:PROFESSIONAL COUNSELING ASSOCIATES CENTER
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING ASSOCIATES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, MCAP
Authorized Official - Phone:321-442-6665
Mailing Address - Street 1:21 B ST
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-5025
Mailing Address - Country:US
Mailing Address - Phone:321-442-6665
Mailing Address - Fax:800-883-7015
Practice Address - Street 1:21 B ST
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-5025
Practice Address - Country:US
Practice Address - Phone:321-442-6665
Practice Address - Fax:800-883-7015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management