Provider Demographics
NPI:1477292118
Name:FOUNDATIONS FOR L.I.F.E.
Entity type:Organization
Organization Name:FOUNDATIONS FOR L.I.F.E.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE & FAMILY THERAPIS
Authorized Official - Prefix:
Authorized Official - First Name:ANDROMEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:954-594-6816
Mailing Address - Street 1:6928 NW 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1337
Mailing Address - Country:US
Mailing Address - Phone:954-594-6816
Mailing Address - Fax:
Practice Address - Street 1:6928 NW 30TH AVE # 6928
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1337
Practice Address - Country:US
Practice Address - Phone:954-947-1247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)