Provider Demographics
NPI:1528741279
Name:FRIEND OF A FRIEND COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:FRIEND OF A FRIEND COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC; PHD
Authorized Official - Phone:941-724-4784
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38025-1045
Mailing Address - Country:US
Mailing Address - Phone:941-724-4784
Mailing Address - Fax:
Practice Address - Street 1:1990 MAIN ST STE 750
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-8000
Practice Address - Country:US
Practice Address - Phone:941-724-4784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty