Provider Demographics
NPI:1740677434
Name:CHOSEN ONE ENTERTAINMENT, LLC
Entity type:Organization
Organization Name:CHOSEN ONE ENTERTAINMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-961-1618
Mailing Address - Street 1:14050 BISCAYNE BLVD
Mailing Address - Street 2:APT 314
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33181-1537
Mailing Address - Country:US
Mailing Address - Phone:850-294-5855
Mailing Address - Fax:
Practice Address - Street 1:1200 BRICKELL AVE
Practice Address - Street 2:SUITE 1950
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3214
Practice Address - Country:US
Practice Address - Phone:305-961-1618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOSEN ONE ENTERTAINMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW91631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty