Provider Demographics
NPI:1134571078
Name:CHRISTIAN COUNSELING ASSOCIATES OF JACKSONVILLE
Entity type:Organization
Organization Name:CHRISTIAN COUNSELING ASSOCIATES OF JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:904-509-4253
Mailing Address - Street 1:165 BARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3000
Mailing Address - Country:US
Mailing Address - Phone:904-509-4253
Mailing Address - Fax:
Practice Address - Street 1:822 A1A N STE 310
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-8209
Practice Address - Country:US
Practice Address - Phone:904-758-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-03
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCMFT 0413020312251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable