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Organization
SUNNYSIDE LOVE EXTRAVAGANT GROUP LLC
Active
Organization
SUNNYSIDE LOVE EXTRAVAGANT GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TABITHA S TAYLOR-BOONE LCSW, CAMS II, NP (OWNER)
(786) 575-3801
Entity
Organization
Contact information
Practice address
3600 S STATE ROAD 7 STE 344, MIRAMAR, FL 33023-7203
(786) 575-3801
(877) 384-2630
Mailing address
3600 S STATE ROAD 7 STE 344, MIRAMAR, FL 33023-7203
(786) 575-3801
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
101YS0200X
School Counselor
—
—
103K00000X
Behavior Analyst
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
1041S0200X
School Social Worker
—
—
174H00000X
Health Educator
—
—
251B00000X
Case Management Agency
—
—
251G00000X
Community Based Hospice Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022925900
—
FL
01
—
1750945689
NPI
FL
Enumeration date
03/04/2020
Last updated
08/08/2021
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