Provider Demographics
NPI:1588017933
Name:L&L CLINICAL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:L&L CLINICAL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHONDA
Authorized Official - Middle Name:HAROLYN
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:772-333-6488
Mailing Address - Street 1:130 S INDIAN RIVER DRIVE
Mailing Address - Street 2:STE 202
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34952
Mailing Address - Country:US
Mailing Address - Phone:772-333-6488
Mailing Address - Fax:
Practice Address - Street 1:130 S INDIAN RIVER DRIVE
Practice Address - Street 2:STE 202
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34952
Practice Address - Country:US
Practice Address - Phone:772-333-6488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC 010575 2015101YA0400X
FLMH 13816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty