Provider Demographics
NPI:1306562673
Name:COSTA, EDEN MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:MARIE
Last Name:COSTA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15575 MIAMI LAKEWAY N APT 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5577
Mailing Address - Country:US
Mailing Address - Phone:786-329-9935
Mailing Address - Fax:
Practice Address - Street 1:15575 MIAMI LAKEWAY N APT 104
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-5577
Practice Address - Country:US
Practice Address - Phone:786-329-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health