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General NPI Number Information
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NPI Number | 1417548249
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Entity Type | Organization
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Legal Business Name | AURILIA'S PLACE A PLACE TO CALL HOME LLC
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 744 NW 12TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-7102
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Country | US
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Telephone | 754-249-6359
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Fax |
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Provider Business Mailing Address
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Address Line | 2551 NW 103RD AVE APT 109
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City | SUNRISE
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State | FL
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Zip | 33322-6805
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Country | US
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Telephone | 754-249-6359
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/COUNSELOR
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Name | AURILIA JOANN GRAY-GRIMES
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Credential | LICENSED MHC
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Telephone | 754-249-6359
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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 |
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License Number State |
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