Provider Demographics
NPI:1396177390
Name:WELLNESS COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:WELLNESS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER/MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:CARRION
Authorized Official - Last Name:CERPA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-335-6455
Mailing Address - Street 1:905 BRICKELL BAY DR
Mailing Address - Street 2:SUITE 228
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2935
Mailing Address - Country:US
Mailing Address - Phone:305-335-6455
Mailing Address - Fax:
Practice Address - Street 1:905 BRICKELL BAY DR
Practice Address - Street 2:SUITE 228
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2935
Practice Address - Country:US
Practice Address - Phone:305-335-6455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11707101YM0800X
FLSW21711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1730425778OtherINDIVIDUAL NPI
FL1497893564OtherINDIVIDUAL NPI