Healthcare Provider Details

I. General information

NPI: 1033553672
Provider Name (Legal Business Name): CARLA BRINKERHOFF LOPEZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N OCEAN BLVD FL 2
FORT LAUDERDALE FL
33308-6424
US

IV. Provider business mailing address

1527 NE 4TH AVE
FORT LAUDERDALE FL
33304-1035
US

V. Phone/Fax

Practice location:
  • Phone: 954-835-5741
  • Fax: 954-835-5746
Mailing address:
  • Phone: 954-835-5741
  • Fax: 954-835-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8045
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8045
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8045
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: