| Sunshine State Counseling Center Llc | |
|
13130 Westlinks Ter Ste 8 Fort Myers FL 33913-8651 | |
| (239) 495-7722 | |
| (239) 443-4577 |
| Full Name | Sunshine State Counseling Center Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 13130 Westlinks Ter Ste 8, Fort Myers, Florida |
| Authorized Official Name and Position | Diana Milena Salazar (OWNER) |
| Authorized Official Contact | 2394957722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunshine State Counseling Center Llc 3575 Bonita Beach Rd Suite 2 Bonita Springs FL 34134-4199 Ph: (239) 495-7722 | Sunshine State Counseling Center Llc 13130 Westlinks Ter Ste 8 Fort Myers FL 33913-8651 Ph: (239) 495-7722 |
| NPI Number | 1699152553 |
|---|---|
| Provider Enumeration Date | 04/29/2015 |
| Last Update Date | 07/23/2024 |
| Certification Date | 07/23/2024 |
| Medicare PECOS PAC ID | 2668907809 |
|---|---|
| Medicare Enrollment ID | O20241125000938 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699152553 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW12686 (Florida) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Diana Milena Salazar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285995357 PECOS PAC ID: 3577098714 Enrollment ID: I20241125001155 |
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