Healthcare Provider Details

I. General information

NPI: 1780404418
Provider Name (Legal Business Name): TD EDUCATIONAL SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 COCOPLUM CIRCLE
COCONUT CREEK FL
33063-5934
US

IV. Provider business mailing address

3701 COCOPLUM CIRCLE
COCONUT CREEK FL
33063-5934
US

V. Phone/Fax

Practice location:
  • Phone: 954-571-2230
  • Fax:
Mailing address:
  • Phone: 954-571-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. LATASHA SHANTE' KENDRICK
Title or Position: CEO
Credential: LMHC
Phone: 954-574-2230