Healthcare Provider Details

I. General information

NPI: 1447514328
Provider Name (Legal Business Name): JACQUELINE DARMONT, L.M.H.C, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 SW 120TH ST
PINECREST FL
33156-4835
US

IV. Provider business mailing address

6450 SW 120TH ST
PINECREST FL
33156-4835
US

V. Phone/Fax

Practice location:
  • Phone: 786-342-8792
  • Fax:
Mailing address:
  • Phone: 786-342-8792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH 8013
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMH 8013
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 8013
License Number StateFL

VIII. Authorized Official

Name: MRS. JACQUELINE DARMONT
Title or Position: DIRECTOR
Credential: M.S, L.M.H.C
Phone: 786-342-8792