Provider Demographics
NPI:1821468539
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:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:C
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 1:316 N JOHN YOUNG PKWY STE 4
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4981
Practice Address - Country:US
Practice Address - Phone:321-442-6665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-001479-2014101YA0400X
FLMH11233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty