Healthcare Provider Details

I. General information

NPI: 1902078447
Provider Name (Legal Business Name): CIRCLE OF LIFE COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SW 18TH AVE
MIAMI FL
33145-3811
US

IV. Provider business mailing address

2301 SW 18TH AVE
MIAMI FL
33145-3811
US

V. Phone/Fax

Practice location:
  • Phone: 305-764-1489
  • Fax:
Mailing address:
  • Phone: 305-764-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ADALYS M MARTINEZ
Title or Position: OWNER
Credential:
Phone: 305-764-1489