Provider Demographics
NPI:1902886781
Name:COMMUNITY COUNSELING CENTER OF CENTRAL FLORIDA, LLC.
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING CENTER OF CENTRAL FLORIDA, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CORRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINDYL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-291-8009
Mailing Address - Street 1:PO BOX 161585
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-1585
Mailing Address - Country:US
Mailing Address - Phone:407-291-8009
Mailing Address - Fax:407-770-5503
Practice Address - Street 1:3544 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2922
Practice Address - Country:US
Practice Address - Phone:407-291-8009
Practice Address - Fax:407-770-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2015-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5580251S00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty