| Center Of Agape Christian Counseling, Llc | |
|
4907 Van Dyke Rd Lutz FL 33558-4813 | |
| (813) 962-1018 | |
| (813) 265-3966 |
| Full Name | Center Of Agape Christian Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4907 Van Dyke Rd, Lutz, Florida |
| Authorized Official Name and Position | Mildred W Phillips (OWNER) |
| Authorized Official Contact | 8139621018 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center Of Agape Christian Counseling, Llc 4907 Van Dyke Rd Lutz FL 33558-4813 Ph: (813) 962-1018 | Center Of Agape Christian Counseling, Llc 4907 Van Dyke Rd Lutz FL 33558-4813 Ph: (813) 962-1018 |
| NPI Number | 1184091183 |
|---|---|
| Provider Enumeration Date | 08/25/2015 |
| Last Update Date | 08/25/2015 |
| Medicare PECOS PAC ID | 0648568873 |
|---|---|
| Medicare Enrollment ID | O20231120002705 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184091183 | NPI | - | NPPES |
| 002809400 | Medicaid | FL | |
| BL767A | Other | FL | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW1370 (Florida) | Primary |
| Provider Name | Mildred W Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053429852 PECOS PAC ID: 7113084096 Enrollment ID: I20231120003001 |
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