Provider Demographics
NPI:1629034996
Name:ADULT & CHILD COUNSELING AND PSYCHIATRIC CENTER, P.A.
Entity type:Organization
Organization Name:ADULT & CHILD COUNSELING AND PSYCHIATRIC CENTER, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYKUMAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:BHUJANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-779-9838
Mailing Address - Street 1:5545 N WICKHAM RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7323
Mailing Address - Country:US
Mailing Address - Phone:321-779-9838
Mailing Address - Fax:321-779-4502
Practice Address - Street 1:5545 N WICKHAM RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7323
Practice Address - Country:US
Practice Address - Phone:321-779-9838
Practice Address - Fax:321-779-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLME403622084P0800X
FLSW3652104100000X
FLSW3614104100000X
FLME505342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253817200Medicaid
FL253817200Medicaid