Provider Demographics
NPI:1932637253
Name:SHILOH COUNSELING CENTER
Entity Type:Organization
Organization Name:SHILOH COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN LILLY
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:850-516-1202
Mailing Address - Street 1:8490 LA SALLE DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-2439
Mailing Address - Country:US
Mailing Address - Phone:850-516-1202
Mailing Address - Fax:
Practice Address - Street 1:8490 LA SALLE DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-2439
Practice Address - Country:US
Practice Address - Phone:850-516-1202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW102341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty