Provider Demographics
NPI:1649308768
Name:PEACE TIME COUNSELING CENTER LLC
Entity type:Organization
Organization Name:PEACE TIME COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:ANDERSEN
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:386-943-9443
Mailing Address - Street 1:1025 W NEW YORK AVENUE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720
Mailing Address - Country:US
Mailing Address - Phone:386-943-9443
Mailing Address - Fax:386-943-9883
Practice Address - Street 1:1025 W NEW YORK AVENUE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-943-9443
Practice Address - Fax:386-943-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2178103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54840OtherBCBS OF FL
FL54840OtherBCBS OF FL