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General NPI Number Information
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NPI Number | 1710009873
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Entity Type | Organization
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Legal Business Name | COMPLETE COUNSELING GROUP, INC.
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 3115 NW 10TH TER STE 103
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-5937
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Country | US
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Telephone | 954-732-5418
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Fax | 954-772-1023
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Provider Business Mailing Address
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Address Line | 333 NW 46TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-4010
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Country | US
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Telephone | 954-732-5418
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Fax | 954-772-1023
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Authorized Official
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Title or Position | PRESIDENT EXECUTIVE DIRECTOR
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Name | MS. DEBRA J TANTILLO
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Credential | LCSW
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Telephone | 954-732-5418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | SW5538
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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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