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General NPI Number Information
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NPI Number | 1285053553
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Entity Type | Organization
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Legal Business Name | ENRICHMENT SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 701 PROMENADE DR SUITE 204
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-6034
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Country | US
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Telephone | 954-364-8842
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 ONYX RD
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City | MIRAMAR
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State | FL
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Zip | 33025-2821
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Country | US
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Telephone | 954-257-7394
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Fax | 954-251-0562
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MRS. ANSE DANIEL
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Credential | LMFT
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Telephone | 954-257-7394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | L14000040502
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License Number State | FL
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