Provider Demographics
NPI:1780561373
Name:FDC COUNSELING AND WELLNESS LLC
Entity type:Organization
Organization Name:FDC COUNSELING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:BAZO
Authorized Official - Last Name:FERNANDEZ DE CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:786-395-9162
Mailing Address - Street 1:1450 MADRUGA AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3165
Mailing Address - Country:US
Mailing Address - Phone:786-395-9162
Mailing Address - Fax:
Practice Address - Street 1:1450 MADRUGA AVE STE 407
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3165
Practice Address - Country:US
Practice Address - Phone:786-395-9162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health