MEDICARE: GRANDE COUNSELING & CONSULTING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1538766464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDE COUNSELING & CONSULTING, LLC

Provider Business Mailing Address
First Line	:	9210 SAFFRON CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8065
Country	:	US
Telephone Number	:	904-477-1776
Fax Number	:

Provider Business Practice Location Address
First Line	:	8837 GOODBYS EXECUTIVE DR STE 205
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4605
Country	:	US
Telephone Number	:	904-610-9269
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAROL GRANDE
Credential	:	LMHC
Telephone Number	:	904-477-1776

Provider Enumeration Date	:	10/05/2020
Last Update Date	:	07/08/2024

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