Healthcare Provider Details

I. General information

NPI: 1235544727
Provider Name (Legal Business Name): LIFELINE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N UNIVERSITY DR
PEMBROKE PINES FL
33024-3611
US

IV. Provider business mailing address

2225 N UNIVERSITY DR
PEMBROKE PINES FL
33024-3611
US

V. Phone/Fax

Practice location:
  • Phone: 954-544-4991
  • Fax: 954-544-4992
Mailing address:
  • Phone: 954-544-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMC1579
License Number StateFL

VIII. Authorized Official

Name: JACQUELINE CAGNEY
Title or Position: OWNER
Credential: LMFT
Phone: 954-544-4991