Provider Demographics
NPI:1831434489
Name:PROFESSIONAL COUNSELING LLC
Entity type:Organization
Organization Name:PROFESSIONAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-442-6665
Mailing Address - Street 1:2200 E IRLO BRONSON MEMORIAL HWY
Mailing Address - Street 2:102
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4424
Mailing Address - Country:US
Mailing Address - Phone:321-442-6665
Mailing Address - Fax:
Practice Address - Street 1:2200 E IRLO BRONSON MEMORIAL HWY
Practice Address - Street 2:102
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4424
Practice Address - Country:US
Practice Address - Phone:321-442-6665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-09
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11233251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health