Provider Demographics
NPI:1992976708
Name:UNLIMITED POTENTIALS FOR LIFE
Entity type:Organization
Organization Name:UNLIMITED POTENTIALS FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAFFIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC,
Authorized Official - Phone:561-841-3990
Mailing Address - Street 1:612 DATE PALM DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3227
Mailing Address - Country:US
Mailing Address - Phone:561-841-3990
Mailing Address - Fax:561-863-0087
Practice Address - Street 1:721 US HIGHWAY 1
Practice Address - Street 2:STE 108
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4512
Practice Address - Country:US
Practice Address - Phone:561-841-3990
Practice Address - Fax:561-863-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty