Healthcare Provider Details

I. General information

NPI: 1285872879
Provider Name (Legal Business Name): LIFELINE COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5571 N UNIVERSITY DR #101
CORAL SPRINGS FL
33067
US

IV. Provider business mailing address

5571 N UNIVERSITY DR #101
CORAL SPRINGS FL
33067
US

V. Phone/Fax

Practice location:
  • Phone: 954-544-4991
  • Fax: 954-544-4992
Mailing address:
  • Phone: 954-544-4991
  • Fax: 954-544-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH2618
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8336
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT1579
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE MARIE CAGNEY
Title or Position: OWNER
Credential: LMFT
Phone: 954-544-4992