Organization
CENTER OF AGAPE CHRISTIAN COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILDRED W PHILLIPS LCSW (OWNER)
(813) 962-1018
Entity
Organization
Contact information
Practice address
4907 VAN DYKE RD, LUTZ, FL 33558-4813
(813) 962-1018
(813) 265-3966
Mailing address
4907 VAN DYKE RD, LUTZ, FL 33558-4813
(813) 962-1018
(813) 265-3966
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW1370
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002809400
—
FL
01
—
BL767A
MEDICARE
FL
Enumeration date
08/25/2015
Last updated
08/25/2015
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