Healthcare Provider Details

I. General information

NPI: 1275968372
Provider Name (Legal Business Name): VIDA COUNSELING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2013
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 SW 8TH ST STE 230
CORAL GABLES FL
33134-2290
US

IV. Provider business mailing address

5455 SW 8TH ST STE 230
CORAL GABLES FL
33134-2290
US

V. Phone/Fax

Practice location:
  • Phone: 786-629-8836
  • Fax: 888-241-5711
Mailing address:
  • Phone: 786-629-8836
  • Fax: 888-241-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11235
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2657
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GRISEL CARTAS
Title or Position: VICE-PRESIDENT
Credential: LCSW, BCBA
Phone: 305-397-5013