Provider Demographics
NPI:1770963829
Name:DYNAMIC COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:DYNAMIC COUNSELING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CAP, ACS, CGAC
Authorized Official - Phone:954-368-5819
Mailing Address - Street 1:2424 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1424
Mailing Address - Country:US
Mailing Address - Phone:954-368-5819
Mailing Address - Fax:954-530-1792
Practice Address - Street 1:2424 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1424
Practice Address - Country:US
Practice Address - Phone:954-368-5819
Practice Address - Fax:954-530-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8046261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder