Provider Demographics
NPI:1285027193
Name:FOOTPRINTS COUNSELING
Entity type:Organization
Organization Name:FOOTPRINTS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC, ED.S, CAP, RPT-S
Authorized Official - Prefix:
Authorized Official - First Name:LANICIA
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, EDS, CAP
Authorized Official - Phone:850-491-4437
Mailing Address - Street 1:2014 DELTA BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4853
Mailing Address - Country:US
Mailing Address - Phone:850-491-4437
Mailing Address - Fax:850-386-4583
Practice Address - Street 1:7420 HEIDE HILL TRCE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-5213
Practice Address - Country:US
Practice Address - Phone:850-491-4437
Practice Address - Fax:850-386-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty