Provider Demographics
NPI:1699367623
Name:SUNNY SOUTH BEHAVIORAL HEALTH AND CONSULTING LLC
Entity Type:Organization
Organization Name:SUNNY SOUTH BEHAVIORAL HEALTH AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-546-2522
Mailing Address - Street 1:411 N FEDERAL HWY APT 716
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3488
Mailing Address - Country:US
Mailing Address - Phone:954-546-2522
Mailing Address - Fax:
Practice Address - Street 1:411 N FEDERAL HWY APT 716
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3488
Practice Address - Country:US
Practice Address - Phone:954-546-2522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty