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Organization
COUNSELING ASSOCIATES OF PORT ORANGE, INC.
Active
Organization
COUNSELING ASSOCIATES OF PORT ORANGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATTI K HALL PHD (SECRETARY/TREASURER)
(386) 761-2390
Entity
Organization
Contact information
Practice address
3959 S NOVA RD, SUITE 5, PORT ORANGE, FL 32127-9278
(386) 761-2390
(386) 761-3256
Mailing address
3959 S NOVA RD, SUITE 5, PORT ORANGE, FL 32127-9278
(386) 761-2390
(386) 761-3256
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
SW3855
FL
251S00000X
Community/Behavioral Health Agency
SW3855
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X1496
BLUE CROSS BLUE SHIELD
FL
Enumeration date
12/07/2007
Last updated
12/07/2007
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