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General NPI Number Information
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NPI Number | 1699407809
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Entity Type | Organization
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Legal Business Name | LOURDES CONTRERAS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 494 MAPLE AVE
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City | FORT PIERCE
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State | FL
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Zip | 34982-5949
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Country | US
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Telephone | 772-245-0048
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Fax |
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Provider Business Mailing Address
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Address Line | 761 SW JASLO AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-3940
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Country | US
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Telephone | 646-314-2705
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LOURDES CONTRERAS
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Credential | LCSW
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Telephone | 772-245-0048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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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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