Provider Demographics
NPI:1679019624
Name:HEART BONDS COUNSELING, LLC
Entity Type:Organization
Organization Name:HEART BONDS COUNSELING, LLC
Other - Org Name:HEART BONDS COUNSELING & HOME STUDIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, LICENSED CLINICAL SOCIAL WOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-801-3578
Mailing Address - Street 1:600 EAST COLONIAL DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4650
Mailing Address - Country:US
Mailing Address - Phone:407-801-3578
Mailing Address - Fax:407-641-9081
Practice Address - Street 1:600 EAST COLONIAL DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4650
Practice Address - Country:US
Practice Address - Phone:407-801-3578
Practice Address - Fax:407-641-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLSW 13127251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104584200Medicaid