Provider Demographics
NPI:1750771622
Name:EMBRIDGE COUNSELING SERVICES
Entity type:Organization
Organization Name:EMBRIDGE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EMEKA
Authorized Official - Middle Name:OBI
Authorized Official - Last Name:ANYIAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:386-747-6541
Mailing Address - Street 1:508 CORAL TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-6926
Mailing Address - Country:US
Mailing Address - Phone:386-747-6541
Mailing Address - Fax:866-401-6150
Practice Address - Street 1:140 S BEACH ST STE 310
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4409
Practice Address - Country:US
Practice Address - Phone:386-747-6541
Practice Address - Fax:866-401-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2442251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health