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General NPI Number Information
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NPI Number | 1174967681
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Entity Type | Organization
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Legal Business Name | ALLEGIANCE CLINICAL COUNSELING LLC
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Dates
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Enumeration Date | 04/26/2013
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 4835 HOLLYWOOD BLVD 2
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6548
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Country | US
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Telephone | 954-251-2796
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Fax | 754-400-9076
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Provider Business Mailing Address
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Address Line | 4835 HOLLYWOOD BLVD 2
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6548
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Country | US
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Telephone | 954-251-2796
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Fax | 754-400-9076
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Authorized Official
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Title or Position | OWNER
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Name | VIVIAN MATHIS
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Credential | LCSW
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Telephone | 954-251-2796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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