Provider Demographics
NPI:1447852959
Name:CHOICESFLA COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:CHOICESFLA COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSENED CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TORI
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALLACE-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CBIS, RMFTI
Authorized Official - Phone:352-441-4373
Mailing Address - Street 1:17030 NW 162ND TER
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-4329
Mailing Address - Country:US
Mailing Address - Phone:352-441-4373
Mailing Address - Fax:
Practice Address - Street 1:17030 NW 162ND TER
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-4329
Practice Address - Country:US
Practice Address - Phone:352-441-4373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health