Provider Demographics
NPI:1588117923
Name:POSITIVE ALLIANCE MIAMI LLC
Entity type:Organization
Organization Name:POSITIVE ALLIANCE MIAMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:CAROLINA
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-457-1036
Mailing Address - Street 1:3410 CORAL WAY
Mailing Address - Street 2:502
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3079
Mailing Address - Country:US
Mailing Address - Phone:305-457-1036
Mailing Address - Fax:
Practice Address - Street 1:6625 MIAMI LAKES DR STE 406
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33014-2704
Practice Address - Country:US
Practice Address - Phone:305-457-1036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty