Healthcare Provider Details

I. General information

NPI: 1184080129
Provider Name (Legal Business Name): THE COUNSELING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 SW 3RD AVE
MIAMI FL
33129-2317
US

IV. Provider business mailing address

2840 SW 3RD AVE
MIAMI FL
33129-2317
US

V. Phone/Fax

Practice location:
  • Phone: 305-857-0050
  • Fax: 305-854-4948
Mailing address:
  • Phone: 305-857-0050
  • Fax: 305-854-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3111
License Number StateFL

VIII. Authorized Official

Name: MIRITA SANTANA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 305-857-0050