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Organization
INDENPENDENT CONTRACTOR FOR COUNSELING SERVICES
Active
Organization
INDENPENDENT CONTRACTOR FOR COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LOURDES M. SANCHEZ-RODRIGUEZ LMHC (OWNER/SOLE PROPRIETATOR)
(850) 814-5060
Entity
Organization
Contact information
Practice address
1606 TENNESSEE AVE, LYNN HAVEN, FL 32444-3653
(850) 814-5060
(850) 265-1811
Mailing address
608 SOMMER CIR, PANAMA CITY, FL 32405-3224
(850) 814-5060
(850) 265-1811
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH4860
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
763657100
—
FL
01
—
811551600
MEDICAID- DEVELOPMENTAL SPECIALIST
FL
Enumeration date
04/16/2015
Last updated
04/16/2015
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