Healthcare Provider Details

I. General information

NPI: 1801350517
Provider Name (Legal Business Name): LIONHEARTED COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2019
Last Update Date: 01/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 NW BOCA RATON BLVD STE 209
BOCA RATON FL
33431-7401
US

IV. Provider business mailing address

2263 NW BOCA RATON BLVD STE 209
BOCA RATON FL
33431-7401
US

V. Phone/Fax

Practice location:
  • Phone: 561-617-5396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: FAITH NIECE
Title or Position: OWNER
Credential: LMHC, LMFT
Phone: 561-617-5396