Healthcare Provider Details

I. General information

NPI: 1194869669
Provider Name (Legal Business Name): UNIVERSAL COUNSELING & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10031 PINES BLVD STE 249
PEMBROKE PINES FL
33024-6180
US

IV. Provider business mailing address

PO BOX 260906
PEMBROKE PINES FL
33026-7906
US

V. Phone/Fax

Practice location:
  • Phone: 305-318-5243
  • Fax: 954-435-2980
Mailing address:
  • Phone: 305-318-5243
  • Fax: 954-435-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5897
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT1790
License Number StateFL

VIII. Authorized Official

Name: MS. LIZETTE WILLIAMS
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential:
Phone: 305-318-5243