Provider Demographics
NPI:1447345574
Name:COUNSELING AND RECOVERY CENTER, INC.
Entity type:Organization
Organization Name:COUNSELING AND RECOVERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:772-467-3057
Mailing Address - Street 1:4753 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-3410
Mailing Address - Country:US
Mailing Address - Phone:772-467-3057
Mailing Address - Fax:772-467-3059
Practice Address - Street 1:4753 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-3410
Practice Address - Country:US
Practice Address - Phone:772-467-3057
Practice Address - Fax:772-467-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1556AD805100261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center