Provider Demographics
NPI:1700179868
Name:CHEMICAL DEPENDENCY COUNSELING, INC.
Entity Type:Organization
Organization Name:CHEMICAL DEPENDENCY COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:PMD
Authorized Official - Phone:904-353-2949
Mailing Address - Street 1:300 W ADAMS ST STE 240
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4365
Mailing Address - Country:US
Mailing Address - Phone:904-353-2949
Mailing Address - Fax:904-353-2959
Practice Address - Street 1:300 W ADAMS ST STE 240
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-4365
Practice Address - Country:US
Practice Address - Phone:904-353-2949
Practice Address - Fax:904-353-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1184261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)