Provider Demographics
NPI:1710445044
Name:3 CORD COUNSELING
Entity Type:Organization
Organization Name:3 CORD COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAKEENA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BRANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-603-9710
Mailing Address - Street 1:725 NORTHLAKE BLVD APT 77
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6732
Mailing Address - Country:US
Mailing Address - Phone:954-494-6730
Mailing Address - Fax:
Practice Address - Street 1:725 NORTHLAKE BLVD APT 77
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6732
Practice Address - Country:US
Practice Address - Phone:954-494-6730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:3 CORD COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty