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Organization
EXULTATION COMMUNITY RESOURCE CENTER
Active
Organization
EXULTATION COMMUNITY RESOURCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PHYLLIS MATHIS (CEO/PRESIDENT)
(954) 478-5835
Entity
Organization
Contact information
Practice address
4000 N STATE ROAD 7 STE 401-2, LAUDERDALE LAKES, FL 33319-4804
(954) 478-5835
Mailing address
517 NW 16TH AVE, FORT LAUDERDALE, FL 33311-8851
(954) 478-5835
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
101YS0200X
School Counselor
—
—
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
104100000X
Social Worker
—
—
1041S0200X
School Social Worker
—
—
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
07/22/2019
Last updated
07/22/2019
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