Provider Demographics
NPI:1245444843
Name:SOUTH FLORIDA CENTER FOR COUNSELING AND THERAPY
Entity type:Organization
Organization Name:SOUTH FLORIDA CENTER FOR COUNSELING AND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-776-3639
Mailing Address - Street 1:2655 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1662
Mailing Address - Country:US
Mailing Address - Phone:954-776-3639
Mailing Address - Fax:
Practice Address - Street 1:2655 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1662
Practice Address - Country:US
Practice Address - Phone:954-776-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW60371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5207XMedicare UPIN