| Paraclete Counseling & Case Management Of Florida Llc | |
|
124 Nw Madison St Lake City FL 32055-3922 | |
| (386) 209-0619 | |
| Not Available |
| Full Name | Paraclete Counseling & Case Management Of Florida Llc |
|---|---|
| Speciality | Social Worker |
| Location | 124 Nw Madison St, Lake City, Florida |
| Authorized Official Name and Position | Fabray Dealow Smith-wiggins (COO) |
| Authorized Official Contact | 3862090619 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paraclete Counseling & Case Management Of Florida Llc 3200 Nw Lake Jeffery Rd Lake City FL 32055-4773 Ph: (386) 209-0619 | Paraclete Counseling & Case Management Of Florida Llc 124 Nw Madison St Lake City FL 32055-3922 Ph: (386) 209-0619 |
| NPI Number | 1508623166 |
|---|---|
| Provider Enumeration Date | 02/29/2024 |
| Last Update Date | 11/08/2024 |
| Certification Date | 11/08/2024 |
| Medicare PECOS PAC ID | 9537695119 |
|---|---|
| Medicare Enrollment ID | O20241205002566 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508623166 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Fabray D Smith-wiggins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821425372 PECOS PAC ID: 9133655715 Enrollment ID: I20241205002802 |
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