Provider Demographics
NPI:1992124424
Name:POSITIVE CHANGE FOR YOU LLC
Entity type:Organization
Organization Name:POSITIVE CHANGE FOR YOU LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-449-8428
Mailing Address - Street 1:19999 E COUNTRY CLUB DR
Mailing Address - Street 2:APT 307
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3081
Mailing Address - Country:US
Mailing Address - Phone:786-449-8428
Mailing Address - Fax:
Practice Address - Street 1:17027 W DIXIE HWY
Practice Address - Street 2:SUITE 125
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3734
Practice Address - Country:US
Practice Address - Phone:786-449-8428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty