Organization
CLEARWATER COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY ANN LANE BCD, LCSW (SOLE MBR)
(727) 417-4491
Entity
Organization
Contact information
Practice address
25400 US HIGHWAY 19 N, SUITE 172, CLEARWATER, FL 33763-2149
(727) 797-7211
Mailing address
3030 HOMESTEAD CT, CLEARWATER, FL 33759-1619
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
SW 3074
FL
Other
Enumeration date
04/05/2016
Last updated
04/05/2016
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