MEDICARE: DIVERSE SOLUTIONS COUNSELING, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1598352866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSE SOLUTIONS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	10101 W SAMPLE RD # 430
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10101 W SAMPLE RD # 430
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3907
Country	:	US
Telephone Number	:	561-365-6139
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SANDRA DAUPHIN
Credential	:	LMFT
Telephone Number	:	561-460-6162

Provider Enumeration Date	:	12/21/2020
Last Update Date	:	12/21/2020

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