=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720567605
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OBSTACLES 2 OPPORTUNITIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2018
-----------------------------------------------------
Last Update Date | 02/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 HOLLYWOOD BLVD STE 410
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-6615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-702-9021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2131 HOLLYWOOD BLVD STE 405
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-6787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-702-9021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | LAMORA PACE
-----------------------------------------------------
Credential | LCSW, CAP
-----------------------------------------------------
Telephone | 954-702-9021
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | ADC-001430-2014
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW9459
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------