1114294824 NPI number — FAMILY LIFE CHRISTIAN COUNSELING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114294824 NPI number — FAMILY LIFE CHRISTIAN COUNSELING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY LIFE CHRISTIAN COUNSELING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114294824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 CORPORATE SQUARE BLVD.
Provider Second Line Business Mailing Address:
SUITE 251
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-1992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-725-1800
Provider Business Mailing Address Fax Number:
904-725-6241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 CORPORATE SQUARE BLVD.
Provider Second Line Business Practice Location Address:
SUITE 251
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-1992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-725-1800
Provider Business Practice Location Address Fax Number:
904-725-6241
Provider Enumeration Date:
11/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SCHROYER
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
RAYMOND
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-725-1800

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW4361 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com