Healthcare Provider Details

I. General information

NPI: 1326705682
Provider Name (Legal Business Name): DIVINE LOVE & HEALING CLINICAL COUNSELING & CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 NW 106TH TER
PLANTATION FL
33322-3536
US

IV. Provider business mailing address

1870 NW 106TH TER
PLANTATION FL
33322-3536
US

V. Phone/Fax

Practice location:
  • Phone: 786-343-4474
  • Fax:
Mailing address:
  • Phone: 786-343-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN ALEXANDER PIEDRAHITA
Title or Position: CLINICAL DIRECTOR
Credential: LMHC, LMHFT
Phone: 786-343-4474