Healthcare Provider Details

I. General information

NPI: 1548909062
Provider Name (Legal Business Name): INTRACOASTAL COUNSELING CENTER SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1604 16TH LN # A
GREENACRES FL
33463-4360
US

IV. Provider business mailing address

1604 16TH LN # A
GREENACRES FL
33463-4360
US

V. Phone/Fax

Practice location:
  • Phone: 561-727-9166
  • Fax: 561-223-9040
Mailing address:
  • Phone: 561-727-9166
  • Fax: 561-223-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JODI RABKIN-TURNER
Title or Position: OWNER/THERAPIST
Credential: LMHC, LPC, MCAP
Phone: 561-727-9166