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General NPI Number Information
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NPI Number | 1588017933
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Entity Type | Organization
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Legal Business Name | L&L CLINICAL COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 130 S INDIAN RIVER DRIVE STE 202
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City | FORT PIERCE
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State | FL
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Zip | 34952
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Country | US
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Telephone | 772-333-6488
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Fax |
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Provider Business Mailing Address
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Address Line | 130 S INDIAN RIVER DRIVE STE 202
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City | FORT PIERCE
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State | FL
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Zip | 34952
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Country | US
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Telephone | 772-333-6488
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LASHONDA HAROLYN HENDERSON
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Credential | LMHC
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Telephone | 772-333-6488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ADC 010575 2015
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 13816
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License Number State | FL
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