Basic Information
| Provider Information | |||||||||
| NPI: | 1548856933 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONNECT TO COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 W BEAVER ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322041415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046486200 | ||||||||
| FaxNumber: | 9046486300 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 W BEAVER ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322041415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046486200 | ||||||||
| FaxNumber: | 9046486300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2020 | ||||||||
| LastUpdateDate: | 12/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRYANT | ||||||||
| AuthorizedOfficialFirstName: | CHARITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9046486200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.