MEDICARE: CNC 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	251S00000X	Community/Behavioral Health Agency
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1275257701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CNC COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1975 E SUNRISE BLVD STE 709
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1454
Country	:	US
Telephone Number	:	786-897-4814
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 E SUNRISE BLVD STE 709
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1454
Country	:	US
Telephone Number	:	786-627-7879
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	CYNTHIA CONSEILLANT
Credential	:	LCSW
Telephone Number	:	786-627-7879

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	09/28/2022

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