MEDICARE: CARDINAL COUNSELING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1174124622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 7843
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34101-7843
Country	:	US
Telephone Number	:	904-417-8566
Fax Number	:

Provider Business Practice Location Address
First Line	:	2161 16TH AVE SW
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34117-4338
Country	:	US
Telephone Number	:	904-417-8566
Fax Number	:

Authorized Official
Title or Position	:	MGR/OWNER
Name	:	MEGAN K GODDARD
Credential	:	LCSW
Telephone Number	:	904-417-8566

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	11/02/2020

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