Provider Demographics
NPI:1073043980
Name:PREMA COUNSELING & CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:PREMA COUNSELING & CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTOINE-PREDESTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:754-281-7097
Mailing Address - Street 1:1856 N NOB HILL RD STE 237
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6548
Mailing Address - Country:US
Mailing Address - Phone:754-281-7097
Mailing Address - Fax:
Practice Address - Street 1:7800 W OAKLAND PARK BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-1121
Practice Address - Country:US
Practice Address - Phone:754-281-7097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)