Healthcare Provider Details

I. General information

NPI: 1295540110
Provider Name (Legal Business Name): PROFESSIONAL COUNSELING OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S RIDGEWOOD DR STE 7
SEBRING FL
33870-3300
US

IV. Provider business mailing address

119 HEATHER LN
LAKE PLACID FL
33852-6167
US

V. Phone/Fax

Practice location:
  • Phone: 863-359-9539
  • Fax:
Mailing address:
  • Phone: 863-840-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. ANDEA MARIE PETROVICH
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC-S
Phone: 963-359-9539