Provider Demographics
NPI:1982127767
Name:PREMIUM COUNSELING GROUP, LLC
Entity Type:Organization
Organization Name:PREMIUM COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:ABDIEL
Authorized Official - Last Name:DAVILA VINALES
Authorized Official - Suffix:
Authorized Official - Credentials:CAP, SAP
Authorized Official - Phone:407-910-4880
Mailing Address - Street 1:3501 W VINE ST STE 352
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4649
Mailing Address - Country:US
Mailing Address - Phone:407-910-4880
Mailing Address - Fax:
Practice Address - Street 1:3501 W VINE ST STE 352
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4649
Practice Address - Country:US
Practice Address - Phone:407-910-4880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP100038101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty