Healthcare Provider Details

I. General information

NPI: 1598352866
Provider Name (Legal Business Name): DIVERSE SOLUTIONS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 W SAMPLE RD # 430
CORAL SPRINGS FL
33065-3907
US

IV. Provider business mailing address

10101 W SAMPLE RD # 430
CORAL SPRINGS FL
33065-3907
US

V. Phone/Fax

Practice location:
  • Phone: 561-365-6139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA DAUPHIN
Title or Position: OWNER
Credential: LMFT
Phone: 561-460-6162