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General NPI Number Information
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NPI Number | 1710476759
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Entity Type | Organization
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Legal Business Name | BEACON OF HOPE CONSULTATION SERVICES, LLC
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 1946 TYLER ST
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4517
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Country | US
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Telephone | 833-400-4673
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Fax | 833-400-4673
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Provider Business Mailing Address
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Address Line | 1946 TYLER ST
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4517
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Country | US
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Telephone | 833-400-4673
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Fax | 833-400-4673
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Authorized Official
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Title or Position | LICENSE CLINICAL SOCIAL WORKER
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Name | MISS LINDA ADITION
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Credential | LCSW
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Telephone | 833-400-4673
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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 | SW11915
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License Number State | FL
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