Provider Demographics
NPI:1982061537
Name:ABC COUNSELING SERVICES,LLC
Entity Type:Organization
Organization Name:ABC COUNSELING SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CAP
Authorized Official - Phone:407-236-6583
Mailing Address - Street 1:37 N ORANGE AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2459
Mailing Address - Country:US
Mailing Address - Phone:407-488-1809
Mailing Address - Fax:
Practice Address - Street 1:37 N ORANGE AVE STE 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2459
Practice Address - Country:US
Practice Address - Phone:407-488-1809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5848251S00000X
FLMH970251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health