Provider Demographics
NPI:1811306020
Name:THE HEALING CREST COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:THE HEALING CREST COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAMORA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CAP
Authorized Official - Phone:954-702-9021
Mailing Address - Street 1:2500 HOLLYWOOD BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6615
Mailing Address - Country:US
Mailing Address - Phone:754-777-6871
Mailing Address - Fax:
Practice Address - Street 1:2500 HOLLYWOOD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6615
Practice Address - Country:US
Practice Address - Phone:754-777-6871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP ADC-001430-2014101YA0400X
FLCCMS100206-AC251B00000X
FLSW9459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017670800Medicaid