| Entity Name: | SAMARITAN COUNSELING CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Inactive |
| Date Filed: | 16 Jan 1979 (46 years ago) |
| Date of dissolution: | 30 Dec 1998 (26 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 30 Dec 1998 (26 years ago) |
| Document Number: | 745564 |
| FEI/EIN Number | 59-1869068 |
| Address: | 2430 ESTANCIA BOULEVARD, ST 112, CLEARWATER, FL 33761 |
| Mail Address: | 2430 ESTANCIA BLVD, SUITE 112, CLEARWATER, FL 33757 |
| ZIP code: | 33761 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356877047 | 2017-05-02 | 2017-05-02 | 6760 N PINE ISLAND RD, TAMARAC, FL, 333213715, US | 101 SE 3RD AVENUE, FORT LAUDERDALE, FL, 33301, US | |||||||||||||||||
|
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| Phone | +1 561-401-8527 |
Authorized person
| Name | MR. MALLICA DAVID REYNOLDS |
| Role | CLINICAL DIRECTOR |
| Phone | 5614018527 |
Taxonomy
| Taxonomy Code | 320800000X - Mental Illness Community Based Residential Treatment Facility |
| License Number | MT3178 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FIELD, DAVID L | Agent | 1215 HUNTINGTON LANE, SAFETY HARBOR, FL 34695 |
| Name | Role | Address |
|---|---|---|
| HARRIS, II M D NORMAN | Vice President | 155 PALMETTO, BELLEAIR, FL 34616 |
| Name | Role | Address |
|---|---|---|
| HARRIS, II M D NORMAN | Director | 155 PALMETTO, BELLEAIR, FL 34616 |
| MATLTBY, DIANE | Director | 36 COUNTRY CLUB DRIVE, LARGO, FL 33771 |
| WAGENSEIL, ROBERT | Director | 1615 FIRST STREET, INDIAN ROCKS BEACH, FL |
| BRISKMAN, JOEL | Director | 66 MIDWAY ISLAND, CLEARWATER, FL 33767 |
| Name | Role | Address |
|---|---|---|
| MATLTBY, DIANE | Secretary | 36 COUNTRY CLUB DRIVE, LARGO, FL 33771 |
| Name | Role | Address |
|---|---|---|
| WAGENSEIL, ROBERT | President | 1615 FIRST STREET, INDIAN ROCKS BEACH, FL |
| Name | Role | Address |
|---|---|---|
| BRISKMAN, JOEL | Treasurer | 66 MIDWAY ISLAND, CLEARWATER, FL 33767 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 1998-12-30 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1998-06-18 | 2430 ESTANCIA BOULEVARD, ST 112, CLEARWATER, FL 33761 | No data |
| REGISTERED AGENT NAME CHANGED | 1998-06-18 | FIELD, DAVID L | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1998-06-18 | 1215 HUNTINGTON LANE, SAFETY HARBOR, FL 34695 | No data |
| CHANGE OF MAILING ADDRESS | 1998-06-05 | 2430 ESTANCIA BOULEVARD, ST 112, CLEARWATER, FL 33761 | No data |
| AMENDMENT AND NAME CHANGE | 1997-11-24 | SAMARITAN COUNSELING CENTER, INC. | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 1998-12-30 |
| ANNUAL REPORT | 1998-06-18 |
| Amendment and Name Change | 1997-11-24 |
| ANNUAL REPORT | 1997-05-16 |
| ANNUAL REPORT | 1996-05-21 |
| ANNUAL REPORT | 1995-05-01 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
