Provider Demographics
NPI:1932541703
Name:COUNSELING MOVING AHEAD-LLC
Entity Type:Organization
Organization Name:COUNSELING MOVING AHEAD-LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:ACHILLES
Authorized Official - Last Name:GERAMANIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-992-4082
Mailing Address - Street 1:703 60TH STREET CT E
Mailing Address - Street 2:STE F
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-6278
Mailing Address - Country:US
Mailing Address - Phone:813-992-4082
Mailing Address - Fax:941-251-4053
Practice Address - Street 1:703 60TH STREET CT E
Practice Address - Street 2:STE F
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-6278
Practice Address - Country:US
Practice Address - Phone:813-992-4082
Practice Address - Fax:941-251-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW101201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW10120OtherLICENSE CLINICAL SOCIAL WORKER