Provider Demographics
NPI:1013949361
Name:ALPHA CHRISTIAN COUNSELING SVCS OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:ALPHA CHRISTIAN COUNSELING SVCS OF CENTRAL FLORIDA
Other - Org Name:ALPHA COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANILO
Authorized Official - Middle Name:
Authorized Official - Last Name:POLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-240-7003
Mailing Address - Street 1:8000 S ORANGE AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-6747
Mailing Address - Country:US
Mailing Address - Phone:407-240-7003
Mailing Address - Fax:407-240-7003
Practice Address - Street 1:8000 S ORANGE AVE STE 111
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-6747
Practice Address - Country:US
Practice Address - Phone:407-240-7003
Practice Address - Fax:407-240-7003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA CHRISTIAN COUNSELING SVCS OF CENTRAL FLORIDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8231251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018742300Medicaid