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General NPI Number Information
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NPI Number | 1407357437
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Entity Type | Organization
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Legal Business Name | PALM COAST COUNSELING, LLC
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Dates
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Enumeration Date | 02/25/2018
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 1 HARGROVE GRADE, STE B-1
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City | PALM COAST
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State | FL
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Zip | 32137
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Country | US
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Telephone | 386-643-3115
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Fax | 386-276-3474
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Provider Business Mailing Address
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Address Line | 54 WELLESLEY LN
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City | PALM COAST
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State | FL
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Zip | 32164-7867
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Country | US
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Telephone | 386-643-3115
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Fax | 386-276-3474
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | CYNTHIA D HAIRSTON
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Credential | LMHC
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Telephone | 386-451-0684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH12217
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License Number State | FL
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Taxonomy #2
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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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