1932484466 NPI number — UNIFIED COUNSELING & MEDIATION PLLC

Table of content: (NPI 1932484466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932484466 NPI number — UNIFIED COUNSELING & MEDIATION PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIFIED COUNSELING & MEDIATION PLLC
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:
1932484466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7451 RIVIERA BLVD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33023-6569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-918-2588
Provider Business Mailing Address Fax Number:
305-974-1360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7451 RIVIERA BLVD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33023-6569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-918-2588
Provider Business Practice Location Address Fax Number:
305-974-1360
Provider Enumeration Date:
10/16/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WIMES
Authorized Official First Name:
CASSAUNDRA
Authorized Official Middle Name:
TENNILLE
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
305-918-2588

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  PY 8192 , 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: 013070800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003127500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".