Provider Demographics
NPI:1851439434
Name:AMERICAN FAMILY COUNSELING
Entity Type:Organization
Organization Name:AMERICAN FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GALLICHIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMCH,CAP
Authorized Official - Phone:954-772-7696
Mailing Address - Street 1:970 W MCNAB RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1115
Mailing Address - Country:US
Mailing Address - Phone:954-772-7696
Mailing Address - Fax:954-977-3985
Practice Address - Street 1:970 W MCNAB RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1115
Practice Address - Country:US
Practice Address - Phone:954-772-7696
Practice Address - Fax:954-977-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL438101YA0400X
FL4097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0932Medicare PIN