Organization
FAMILY COUNSELING CENTER OF BREVARD, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP KOLODZIEJ MSW, ACSW (PRESIDENT)
(321) 632-5792
Entity
Organization
Contact information
Practice address
840 BREVARD AVE, ROCKLEDGE, FL 32955-2149
(321) 632-5792
(321) 632-5796
Mailing address
840 BREVARD AVE, ROCKLEDGE, FL 32955-2149
(321) 632-5792
(321) 632-5796
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
SW5110
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060332500
—
FL
01
—
275862
CLINICAL SOCIAL WORKER
FL
01
—
62-40039
CLINICAL SOCIAL WORKER
FL
Enumeration date
01/25/2007
Last updated
04/22/2008
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