Provider Demographics
NPI:1285053553
Name:ENRICHMENT SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:ENRICHMENT SUPPORT SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:954-257-7394
Mailing Address - Street 1:3300 ONYX RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2821
Mailing Address - Country:US
Mailing Address - Phone:954-257-7394
Mailing Address - Fax:954-251-0562
Practice Address - Street 1:701 PROMENADE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-6034
Practice Address - Country:US
Practice Address - Phone:954-364-8842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL14000040502251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health