# IMPACT COUNSELING AND CONSULTING LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639846744
- **Authorized official:** MYRA FAIRLINE RICKETTS (OWNER)
- **Authorized official phone:** (352) 587-2378

## Contact information

- **Practice address:** 3404 N LECANTO HWY STE D, BEVERLY HILLS, FL 34465-3569
- **Practice address phone:** (352) 587-2378
- **Mailing address:** 3404 N LECANTO HWY STE D, BEVERLY HILLS, FL 34465-3569

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 08/26/2021
- **Last updated:** 11/15/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1034121-00 | — | FL |