Provider Demographics
NPI:1336529619
Name:SUPPORT SERVICES CONSULTANTS, LLC
Entity Type:Organization
Organization Name:SUPPORT SERVICES CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-635-6059
Mailing Address - Street 1:3419 COCOPLUM CIR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5924
Mailing Address - Country:US
Mailing Address - Phone:561-635-6059
Mailing Address - Fax:
Practice Address - Street 1:3419 COCOPLUM CIR
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-5924
Practice Address - Country:US
Practice Address - Phone:561-635-6059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8384251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management