Healthcare Provider Details

I. General information

NPI: 1689080780
Provider Name (Legal Business Name): PINECREST COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12368 SW 82 AVE
PINECREST FL
33156
US

IV. Provider business mailing address

10351 SW 119 ST
MIAMI FL
33176
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-5595
  • Fax: 305-259-6015
Mailing address:
  • Phone: 305-667-5595
  • Fax: 305-259-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: IRIS MORE
Title or Position: PRESIDENT.
Credential: L.C.S.W.
Phone: 305-667-5595