Healthcare Provider Details

I. General information

NPI: 1114317013
Provider Name (Legal Business Name): MENTAL HEALTH COUNSELING OF SOUTH FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18656 NW 47 AVE #102 F
MIAMI GARDENS FL
33056
US

IV. Provider business mailing address

18356 NW 47TH AVE
MIAMI GARDENS FL
33056
US

V. Phone/Fax

Practice location:
  • Phone: 954-695-1258
  • Fax:
Mailing address:
  • Phone: 954-695-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberARNP3090472
License Number StateFL

VIII. Authorized Official

Name: MRS. CAROL JOHNSON MCGREGOR
Title or Position: MANAGING MEMBER
Credential: ARNP
Phone: 954-210-6070