Healthcare Provider Details

I. General information

NPI: 1093277550
Provider Name (Legal Business Name): NSC BEHAVIORAL CONCEPTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NE 123RD ST STE 314
NORTH MIAMI FL
33181-2883
US

IV. Provider business mailing address

1801 NE 123RD ST STE 314
NORTH MIAMI FL
33181-2883
US

V. Phone/Fax

Practice location:
  • Phone: 754-300-3503
  • Fax:
Mailing address:
  • Phone: 754-300-3503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE SHERRILL-CORRY
Title or Position: OWNER/CEO
Credential: PH.D.
Phone: 754-300-3503