Organization
PALM COAST COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA D HAIRSTON LMHC (OWNER/ADMINISTRATOR)
(386) 451-0684
Entity
Organization
Contact information
Practice address
1 HARGROVE GRADE, STE B-1, PALM COAST, FL 32137
(386) 643-3115
(386) 276-3474
Mailing address
54 WELLESLEY LN, PALM COAST, FL 32164-7867
(386) 643-3115
(386) 276-3474
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MH12217
FL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010691000
—
FL
Enumeration date
02/25/2018
Last updated
06/15/2020
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