Healthcare Provider Details

I. General information

NPI: 1457796088
Provider Name (Legal Business Name): FEARLESS LOVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 NE 1ST AVE SUITE 104
DELRAY BEACH FL
33444-3715
US

IV. Provider business mailing address

238 NE 1ST AVE SUITE 104
DELRAY BEACH FL
33444-3715
US

V. Phone/Fax

Practice location:
  • Phone: 954-495-4566
  • Fax: 954-495-4566
Mailing address:
  • Phone: 954-495-4566
  • Fax: 954-495-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH 11563
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 11563
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00463000
License Number StateNJ

VIII. Authorized Official

Name: MS. JIANNY D. ADAMO
Title or Position: FOUNDER
Credential: LMHC, LPC, NCC
Phone: 954-495-4566