Provider Demographics
NPI:1598535478
Name:SOUTHERN CARE COUNSELING
Entity Type:Organization
Organization Name:SOUTHERN CARE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:LANDES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:772-405-7255
Mailing Address - Street 1:8130 GLADES RD # 503
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4064
Mailing Address - Country:US
Mailing Address - Phone:772-405-7255
Mailing Address - Fax:
Practice Address - Street 1:5458 TOWN CENTER RD. #7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:772-405-7255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)