Organization
IMPACT COUNSELING AND CONSULTING LLC
Active
Organization
IMPACT COUNSELING AND CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MYRA FAIRLINE RICKETTS LMHC (OWNER)
(352) 587-2378
Entity
Organization
Contact information
Practice address
3404 N LECANTO HWY STE D, BEVERLY HILLS, FL 34465-3569
(352) 587-2378
Mailing address
PO BOX 2581, INVERNESS, FL 34451-2581
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MH16109
FL
251S00000X
Community/Behavioral Health Agency
Primary
MH16109
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017033-00
—
FL
Enumeration date
07/06/2018
Last updated
03/17/2023
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