Provider Demographics
NPI:1518205152
Name:COUNSELING & DISABILITY SERVICES
Entity Type:Organization
Organization Name:COUNSELING & DISABILITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAVIGNA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:386-788-5021
Mailing Address - Street 1:1635 S RIDGEWOOD AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8478
Mailing Address - Country:US
Mailing Address - Phone:386-788-5021
Mailing Address - Fax:386-788-5021
Practice Address - Street 1:1635 S RIDGEWOOD AVE STE 225
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-8478
Practice Address - Country:US
Practice Address - Phone:386-788-5021
Practice Address - Fax:386-788-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FL251B00000X
FLSW9461251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013191700Medicaid
FL678415196OtherMEDICAID WAIVER
FL005978200OtherMEDICAID WAIVER
FL013190700Medicaid