Healthcare Provider Details

I. General information

NPI: 1104473503
Provider Name (Legal Business Name): NEW FOUNDATION COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 SW 137TH AVE STE 225
MIAMI FL
33186-1432
US

IV. Provider business mailing address

9020 SW 137TH AVE STE 225
MIAMI FL
33186-1432
US

V. Phone/Fax

Practice location:
  • Phone: 786-379-4466
  • Fax: 305-363-5957
Mailing address:
  • Phone: 786-379-4466
  • Fax: 305-363-5957

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 Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD RIOS
Title or Position: SECRETARY
Credential:
Phone: 786-379-4466