| Pcc | |
|
1608 Smith St Orange Park FL 32073-4819 | |
| (904) 278-8722 | |
| (904) 278-4880 |
| Full Name | Pcc |
|---|---|
| Speciality | Counselor |
| Location | 1608 Smith St, Orange Park, Florida |
| Authorized Official Name and Position | Toby D Holley (PRESIDENT) |
| Authorized Official Contact | 9042788722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pcc 1608 Smith St Orange Park FL 32073-4819 Ph: (904) 278-8722 | Pcc 1608 Smith St Orange Park FL 32073-4819 Ph: (904) 278-8722 |
| NPI Number | 1538217740 |
|---|---|
| Provider Enumeration Date | 01/07/2007 |
| Last Update Date | 11/29/2023 |
| Certification Date | 11/29/2023 |
| Medicare PECOS PAC ID | 7315396546 |
|---|---|
| Medicare Enrollment ID | O20231213000088 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538217740 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Toby D Holley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295872364 PECOS PAC ID: 0042669590 Enrollment ID: I20231213000111 |
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