Organization
IMPACT COUNSELING AND CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRA FAIRLINE RICKETTS (OWNER)
(352) 587-2378
Entity
Organization
Contact information
Practice address
3404 N LECANTO HWY STE D, BEVERLY HILLS, FL 34465-3569
(352) 419-4856
Mailing address
3404 N LECANTO HWY STE D, BEVERLY HILLS, FL 34465-3569
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/17/2021
Last updated
11/15/2022
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