Healthcare Provider Details

I. General information

NPI: 1376468389
Provider Name (Legal Business Name): LATE BLOOMERS MOTIVATION & EMPOWERMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15621 SW 113TH AVE
MIAMI FL
33157-1108
US

IV. Provider business mailing address

15621 SW 113TH AVE
MIAMI FL
33157-1108
US

V. Phone/Fax

Practice location:
  • Phone: 305-967-2077
  • Fax:
Mailing address:
  • Phone: 305-967-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LASHUNDA HALL
Title or Position: CEO
Credential:
Phone: 305-967-2077