Provider Demographics
NPI:1932484466
Name:UNIFIED COUNSELING & MEDIATION PLLC
Entity Type:Organization
Organization Name:UNIFIED COUNSELING & MEDIATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSAUNDRA
Authorized Official - Middle Name:TENNILLE
Authorized Official - Last Name:WIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-918-2588
Mailing Address - Street 1:7451 RIVIERA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6569
Mailing Address - Country:US
Mailing Address - Phone:305-918-2588
Mailing Address - Fax:305-974-1360
Practice Address - Street 1:7451 RIVIERA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6569
Practice Address - Country:US
Practice Address - Phone:305-918-2588
Practice Address - Fax:305-974-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-16
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8192251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013070800Medicaid
FL003127500Medicaid