Provider Demographics
NPI:1821780040
Name:180 COUNSLEING GROUP LLC
Entity Type:Organization
Organization Name:180 COUNSLEING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-348-4059
Mailing Address - Street 1:2605 72ND AVE E UNIT 583
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-7021
Mailing Address - Country:US
Mailing Address - Phone:941-348-4059
Mailing Address - Fax:
Practice Address - Street 1:4143 DAY BRIDGE PL
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-7236
Practice Address - Country:US
Practice Address - Phone:941-348-4059
Practice Address - Fax:941-803-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health