Provider Demographics
NPI:1952660698
Name:THE HEALING PATH, FAMILY COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:THE HEALING PATH, FAMILY COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-506-4625
Mailing Address - Street 1:3565 HAMMOCK TRL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8321
Mailing Address - Country:US
Mailing Address - Phone:321-506-4625
Mailing Address - Fax:321-723-8233
Practice Address - Street 1:810 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-7418
Practice Address - Country:US
Practice Address - Phone:321-506-4625
Practice Address - Fax:321-723-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty