Provider Demographics
NPI:1124324934
Name:FIRST COMMUNITY CARE
Entity type:Organization
Organization Name:FIRST COMMUNITY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR /LICENSED MENTAL HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARI
Authorized Official - Middle Name:BOZARD
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-514-4470
Mailing Address - Street 1:3125 BRUTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805
Mailing Address - Country:US
Mailing Address - Phone:407-514-4470
Mailing Address - Fax:
Practice Address - Street 1:3125 BRUTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805
Practice Address - Country:US
Practice Address - Phone:407-514-4470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST BAPTIST CHURCH ORLANDO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-27
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
FLMH5041101YM0800X
FL101Y00000X, 101YA0400X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty