Provider Demographics
NPI:1285791764
Name:CORE COUNSELING SERVICE INC
Entity type:Organization
Organization Name:CORE COUNSELING SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:YONTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:386-756-2405
Mailing Address - Street 1:4319 SO RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127
Mailing Address - Country:US
Mailing Address - Phone:386-756-2405
Mailing Address - Fax:386-756-7518
Practice Address - Street 1:4319 SO RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127
Practice Address - Country:US
Practice Address - Phone:386-756-2405
Practice Address - Fax:386-756-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2990Medicare PIN