Healthcare Provider Details

I. General information

NPI: 1215277199
Provider Name (Legal Business Name): FIFTH STREET COUNSELING CENTER IV, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 NW 5TH ST 206
PLANTATION FL
33317-2120
US

IV. Provider business mailing address

4121 NW 5TH ST 206
PLANTATION FL
33317-2120
US

V. Phone/Fax

Practice location:
  • Phone: 954-797-5222
  • Fax: 954-797-7677
Mailing address:
  • Phone: 954-797-5222
  • Fax: 954-797-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHLEEN M RHODES
Title or Position: PRESIDENT
Credential: LMFT
Phone: 954-797-5222