Provider Demographics
NPI:1013048917
Name:VILLAGE COUNSELING CENTER OF GAINESVILLE, INC.
Entity Type:Organization
Organization Name:VILLAGE COUNSELING CENTER OF GAINESVILLE, INC.
Other - Org Name:VILLAGE COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, LMHC
Authorized Official - Phone:352-331-4681
Mailing Address - Street 1:100 SW 75TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-5779
Mailing Address - Country:US
Mailing Address - Phone:352-331-4621
Mailing Address - Fax:352-331-4681
Practice Address - Street 1:100 SW 75TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-5779
Practice Address - Country:US
Practice Address - Phone:352-331-4621
Practice Address - Fax:352-331-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty