Provider Demographics
NPI:1720486533
Name:POSITIVE LIFESTYLES COUNSELING CENTER
Entity Type:Organization
Organization Name:POSITIVE LIFESTYLES COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ATIYA
Authorized Official - Middle Name:BANO
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-436-6210
Mailing Address - Street 1:1637 RACE TRACK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3239
Mailing Address - Country:US
Mailing Address - Phone:904-436-6210
Mailing Address - Fax:904-436-6212
Practice Address - Street 1:1637 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3239
Practice Address - Country:US
Practice Address - Phone:904-436-6210
Practice Address - Fax:904-436-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW69541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty