1043745367 NPI number — SILVER LINING COUNSELING OF LAKALAND, LLC

Table of content: (NPI 1043745367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043745367 NPI number — SILVER LINING COUNSELING OF LAKALAND, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVER LINING COUNSELING OF LAKALAND, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043745367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2563
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33806-2563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-607-6088
Provider Business Mailing Address Fax Number:
863-607-6089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 DORIS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33813-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-607-6088
Provider Business Practice Location Address Fax Number:
863-607-6089
Provider Enumeration Date:
04/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
FERRICA
Authorized Official Middle Name:
THORNTON
Authorized Official Title or Position:
CEO/FOUNDER
Authorized Official Telephone Number:
863-607-6088

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  MM11212 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1679957443 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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