Provider Demographics
NPI:1275968372
Name:VIDA COUNSELING GROUP, LLC
Entity Type:Organization
Organization Name:VIDA COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRISEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCBA
Authorized Official - Phone:305-397-5013
Mailing Address - Street 1:5455 SW 8TH ST STE 230
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2290
Mailing Address - Country:US
Mailing Address - Phone:786-629-8836
Mailing Address - Fax:888-241-5711
Practice Address - Street 1:5455 SW 8TH ST STE 230
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2290
Practice Address - Country:US
Practice Address - Phone:786-629-8836
Practice Address - Fax:888-241-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-08
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL112351041C0700X
FL2657106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty