Healthcare Provider Details

I. General information

NPI: 1750844130
Provider Name (Legal Business Name): EXUM LIFE COUNSELING, MEDIATION, & TRAINING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S PINE ISLAND RD STE 300
PLANTATION FL
33324-2665
US

IV. Provider business mailing address

8336 NW 80TH ST
TAMARAC FL
33321-1628
US

V. Phone/Fax

Practice location:
  • Phone: 954-701-0940
  • Fax:
Mailing address:
  • Phone: 954-701-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ANGELA LEVETTE EXUM
Title or Position: CEO
Credential: LMHC
Phone: 954-701-0940