=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457796088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FEARLESS LOVE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2013
-----------------------------------------------------
Last Update Date | 05/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 238 NE 1ST AVE SUITE 104
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33444-3715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-495-4566
-----------------------------------------------------
Fax | 954-495-4566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 238 NE 1ST AVE SUITE 104
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33444-3715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-495-4566
-----------------------------------------------------
Fax | 954-495-4566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | MS. JIANNY D. ADAMO
-----------------------------------------------------
Credential | LMHC, LPC, NCC
-----------------------------------------------------
Telephone | 954-495-4566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH 11563
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 37PC00463000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | MH 11563
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------