Provider Demographics
NPI:1891313144
Name:AYESTAS, CARLOS A (MS, MHC)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:AYESTAS
Suffix:
Gender:M
Credentials:MS, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17501 SW 117TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2272
Mailing Address - Country:US
Mailing Address - Phone:321-397-3008
Mailing Address - Fax:888-469-0255
Practice Address - Street 1:17501 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2272
Practice Address - Country:US
Practice Address - Phone:321-397-3008
Practice Address - Fax:888-469-0255
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health