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General NPI Number Information
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NPI Number | 1649718974
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Entity Type | Organization
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Legal Business Name | LAUREL OAKS COUNSELING LLC
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 444 SEABREEZE BLVD SUITE 730
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-3958
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Country | US
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Telephone | 386-255-0044
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Fax | 385-255-0045
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Provider Business Mailing Address
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Address Line | 226 N NOVA RD # 148
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5124
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Country | US
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Telephone | 386-255-0044
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA NIXON
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Credential | LCSW
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Telephone | 386-255-0044
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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 | MH6317
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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