Provider Demographics
NPI:1306344502
Name:SOUTHEASTERN COUNSELING AND CONSULTATION LLC
Entity type:Organization
Organization Name:SOUTHEASTERN COUNSELING AND CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:MCDOUGALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-318-8750
Mailing Address - Street 1:PO BOX 357504
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7504
Mailing Address - Country:US
Mailing Address - Phone:352-375-4440
Mailing Address - Fax:352-378-1828
Practice Address - Street 1:5024 NW 27TH CT STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6545
Practice Address - Country:US
Practice Address - Phone:352-375-4440
Practice Address - Fax:352-378-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty