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) 587-2378
Mailing address
3404 N LECANTO HWY STE D, BEVERLY HILLS, FL 34465-3569
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1034121-00
—
FL
Enumeration date
08/26/2021
Last updated
11/15/2022
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