Provider Demographics
NPI:1649603259
Name:CIRCLE OF FRIENDS
Entity type:Organization
Organization Name:CIRCLE OF FRIENDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-717-0982
Mailing Address - Street 1:525 BLACK IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-8106
Mailing Address - Country:US
Mailing Address - Phone:386-717-0982
Mailing Address - Fax:
Practice Address - Street 1:525 BLACK IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-8106
Practice Address - Country:US
Practice Address - Phone:386-717-0982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1467691873Medicaid