Provider Demographics
NPI:1578188033
Name:INTIMATE HEALTHCARE AND COUNSELING, LLC
Entity Type:Organization
Organization Name:INTIMATE HEALTHCARE AND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:MS
Authorized Official - First Name:JAHAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASANTA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:239-800-9972
Mailing Address - Street 1:15275 COLLIER BLVD
Mailing Address - Street 2:SUITE 201 - 336
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119
Mailing Address - Country:US
Mailing Address - Phone:239-800-9972
Mailing Address - Fax:786-590-1618
Practice Address - Street 1:15275 COLLIER BLVD
Practice Address - Street 2:SUITE 201 - 336
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119
Practice Address - Country:US
Practice Address - Phone:239-800-9972
Practice Address - Fax:786-590-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center