=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073441309
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASLEY COUNSELING & CONSULTING GROUP INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2026
-----------------------------------------------------
Last Update Date | 05/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 SE WALTON LAKES DR
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-3484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-624-9325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 SE WALTON LAKES DR
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-3484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-624-9325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING OWNER
-----------------------------------------------------
Name | DR. OLIVIA D EASLEY
-----------------------------------------------------
Credential | PHD LCMHC QS
-----------------------------------------------------
Telephone | 561-401-3408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------