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General NPI Number Information
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NPI Number | 1366956831
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Entity Type | Organization
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Legal Business Name | SRB COUNSELING & CONSULTING PLLC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1100 W MCNAB RD STE 104
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1116
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Country | US
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Telephone | 954-282-9443
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Fax |
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Provider Business Mailing Address
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Address Line | 15757 PINES BLVD # 197
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1207
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Country | US
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Telephone | 954-282-9443
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MS. SHAKEYIA REAUCHEAN SPANN
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Credential | LCSW
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Telephone | 954-282-9443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW14701
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License Number State | FL
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