Healthcare Provider Details

I. General information

NPI: 1992798128
Provider Name (Legal Business Name): AURORA COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 N KILLIAN DR STE 201
LAKE PARK FL
33403-1962
US

IV. Provider business mailing address

1408 N KILLIAN DR STE 201
LAKE PARK FL
33403-1962
US

V. Phone/Fax

Practice location:
  • Phone: 561-881-7044
  • Fax: 561-881-7044
Mailing address:
  • Phone: 561-881-7044
  • Fax: 561-881-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5952
License Number StateFL

VIII. Authorized Official

Name: SUSAN P. KIMBALL
Title or Position: OWNER
Credential: LCSW
Phone: 561-881-7044