| Entity Name: | COUNSELING ASSOCIATES OF PORT ORANGE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 07 Jan 1994 (31 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P94000003766 |
| FEI/EIN Number | 59-3220224 |
| Address: | 3959 S NOVA RD, SUITE 5, PORT ORANGE, FL 32127 |
| Mail Address: | 6181 SHORELINE CIR NORTH, PORT ORANGE, FL 32127 |
| ZIP code: | 32127 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003099516 | 2007-12-07 | 2007-12-07 | 3959 S NOVA RD, SUITE 5, PORT ORANGE, FL, 321279278, US | 3959 S NOVA RD, SUITE 5, PORT ORANGE, FL, 321279278, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 386-761-2390 |
| Fax | 3867613256 |
Authorized person
| Name | DR. PATTI K HALL |
| Role | SECRETARY/TREASURER |
| Phone | 3867612390 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | SW3855 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | SW3855 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | X1496 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PENNELL, ROBERT CP | Agent | 3959 S NOVA RD, SUITE 5, PORT ORANGE, FL 32127 |
| Name | Role | Address |
|---|---|---|
| PENNELL, ROBERT CP | President | 3959 S NOVA RD STE. 5, PORT ORANGE, FL 32127 |
| Name | Role | Address |
|---|---|---|
| PENNELL, ROBERT CP | Secretary | 3959 S NOVA RD STE. 5, PORT ORANGE, FL 32127 |
| Name | Role | Address |
|---|---|---|
| PENNELL, ROBERT CP | Treasurer | 3959 S NOVA RD STE. 5, PORT ORANGE, FL 32127 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2012-09-21 | 3959 S NOVA RD, SUITE 5, PORT ORANGE, FL 32127 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-05 | 3959 S NOVA RD, SUITE 5, PORT ORANGE, FL 32127 | No data |
| REGISTERED AGENT NAME CHANGED | 2008-01-18 | PENNELL, ROBERT CP | No data |
| AMENDED AND RESTATEDARTICLES | 1995-10-30 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-04-05 |
| ANNUAL REPORT | 2010-04-10 |
| ANNUAL REPORT | 2009-02-21 |
| ANNUAL REPORT | 2008-01-18 |
| ANNUAL REPORT | 2007-01-08 |
| ANNUAL REPORT | 2006-01-03 |
| ANNUAL REPORT | 2005-02-14 |
| ANNUAL REPORT | 2004-01-31 |
| ANNUAL REPORT | 2003-03-21 |
| ANNUAL REPORT | 2002-02-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
