Healthcare Provider Details

I. General information

NPI: 1174093983
Provider Name (Legal Business Name): EMERGENT COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W OAKLAND PARK BLVD STE 410-4
OAKLAND PARK FL
33311-1388
US

IV. Provider business mailing address

2701 W OAKLAND PARK BLVD STE 410-4
OAKLAND PARK FL
33311-1388
US

V. Phone/Fax

Practice location:
  • Phone: 954-533-4828
  • Fax: 754-206-2930
Mailing address:
  • Phone: 954-790-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICKY SYBONIE CAMERON
Title or Position: MANAGING DIRECTOR
Credential: LCSW, CBHCMS
Phone: 954-533-4828