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General NPI Number Information
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NPI Number | 1992124424
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Entity Type | Organization
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Legal Business Name | POSITIVE CHANGE FOR YOU LLC
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 17027 W DIXIE HWY SUITE 125
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-3734
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Country | US
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Telephone | 786-449-8428
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Fax |
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Provider Business Mailing Address
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Address Line | 19999 E COUNTRY CLUB DR APT 307
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City | AVENTURA
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State | FL
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Zip | 33180-3081
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Country | US
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Telephone | 786-449-8428
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DANIELLE JACOBS
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Credential | LMHC
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Telephone | 786-449-8428
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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 | MH11761
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License Number State | FL
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