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General NPI Number Information
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NPI Number | 1629556840
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Entity Type | Organization
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Legal Business Name | THE ONYX COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 6361 PRESIDENTIAL CT STE 101
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City | FORT MYERS
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State | FL
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Zip | 33919
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Country | US
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Telephone | 845-709-3255
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Fax |
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Provider Business Mailing Address
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Address Line | 3851 TILBOR CIR
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City | FORT MYERS
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State | FL
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Zip | 33916-8046
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Country | US
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Telephone | 845-709-3255
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COLLEEN MARTENS
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Credential | LCSW
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Telephone | 845-709-3255
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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 | SW12607
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License Number State | FL
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