Healthcare Provider Details

I. General information

NPI: 1821780040
Provider Name (Legal Business Name): 180 COUNSELING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 12/04/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4143 DAY BRIDGE PL
ELLENTON FL
34222-7236
US

IV. Provider business mailing address

2605 72ND AVE E UNIT 583
ELLENTON FL
34222-7021
US

V. Phone/Fax

Practice location:
  • Phone: 941-348-4059
  • Fax: 941-803-4215
Mailing address:
  • Phone: 941-348-4059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EDDIE COLLINS
Title or Position: OWNER
Credential:
Phone: 941-348-4059