Healthcare Provider Details

I. General information

NPI: 1982936803
Provider Name (Legal Business Name): CENTER FOR CHILD AND FAMILY COUNSELING,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14707 S DIXIE HWY SUITE #317
MIAMI FL
33176-7948
US

IV. Provider business mailing address

14707 S DIXIE HWY SUITE #317
MIAMI FL
33176-7948
US

V. Phone/Fax

Practice location:
  • Phone: 305-254-9600
  • Fax: 305-662-9889
Mailing address:
  • Phone: 305-254-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH0205512
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 5512
License Number StateFL

VIII. Authorized Official

Name: DR. STELLA M. VERNA ROSS
Title or Position: PRESIDENT
Credential: PH D
Phone: 305-254-9600