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Organization
NOVA SOUTHEASTERN UNIVERSITY, INC
Active
Organization
NOVA SOUTHEASTERN UNIVERSITY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKEITHA BAKER (CREDENTIALING SUPERVISOR)
(954) 262-9416
Entity
Organization
Contact information
Practice address
3151 COLLEGE AVENUE, MAXWELL MALTZ BUILDING 1ST FLOOR, DAVIE, FL 33314
(954) 262-3030
Mailing address
PO BOX 290370, DAVIE, FL 33329-0370
(954) 262-4343
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103T00000X
Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
08/09/2022
Last updated
08/27/2025
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