Healthcare Provider Details

I. General information

NPI: 1821659186
Provider Name (Legal Business Name): COUNSELOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 BLUE LAGOON DR # 891
MIAMI FL
33126-2064
US

IV. Provider business mailing address

5201 BLUE LAGOON DR # 891
MIAMI FL
33126-2064
US

V. Phone/Fax

Practice location:
  • Phone: 786-497-4998
  • Fax:
Mailing address:
  • Phone: 786-497-4998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ASHLEY DOMINGUEZ
Title or Position: OWNER
Credential: MS., LMHC
Phone: 786-497-4998