Healthcare Provider Details

I. General information

NPI: 1982002457
Provider Name (Legal Business Name): PELLON COMMUNITY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 1ST AVE
HIALEAH FL
33010-4808
US

IV. Provider business mailing address

300 E 1ST AVE
HIALEAH FL
33010-4808
US

V. Phone/Fax

Practice location:
  • Phone: 786-712-9941
  • Fax:
Mailing address:
  • Phone: 786-712-9941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CELIA R PELLON
Title or Position: MHC/PRESIDENT
Credential: MS,MHC
Phone: 786-712-9941