Healthcare Provider Details

I. General information

NPI: 1467414938
Provider Name (Legal Business Name): MIAMI-DADE COUNSELING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW 1ST ST STE 230
MIAMI FL
33135-1601
US

IV. Provider business mailing address

1901 SW 1ST ST STE 230
MIAMI FL
33135-1601
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-8933
  • Fax: 305-631-0546
Mailing address:
  • Phone: 305-631-8933
  • Fax: 305-631-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberME10491
License Number StateFL

VIII. Authorized Official

Name: ANGEL GUTIERREZ
Title or Position: PRESIDENT
Credential:
Phone: 305-631-8933