Provider Demographics
NPI:1881130094
Name:NORTHLAKE CENTER FOR COUNSELING
Entity type:Organization
Organization Name:NORTHLAKE CENTER FOR COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE MENTAL HEALT
Authorized Official - Phone:561-743-7958
Mailing Address - Street 1:1851 WEST INDIANTOWN ROAD
Mailing Address - Street 2:#202
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-743-7959
Mailing Address - Fax:561-743-7959
Practice Address - Street 1:1851 WEST INDIANTOWN ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-743-7958
Practice Address - Fax:561-743-7959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty