Chrysalis Counseling Center LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

CHRYSALIS COUNSELING CENTER LLC

Practice address

3930 S Nova Rd Ste 303
Port Orange, FL 32127-9293

Phone

(386) 310-7436

Fax

(386) 259-6112

NPI assigned

Sep 9, 2020

Last updated

Dec 18, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Brenda C Rockwell, LMHCNPI 1942636584

Title

Owner

Phone

(386) 310-7436

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brenda C. Rockwell, M.A.

  • Mental Health Counselor
  • Port Orange, FL
  • NPI 1942636584
  NPD Authorized official
• Marilourdes Perez, MA, LMHC

  • Mental Health Counselor
  • Port Orange, FL
  • NPI 1124366430
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608249600000",
    "number": "1356956114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 S NOVA RD STE 303",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279293",
            "telephone_number": "386-310-7436",
            "fax_number": "386-259-6112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 S NOVA RD STE 303",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279293",
            "telephone_number": "386-310-7436",
            "fax_number": "386-259-6112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRYSALIS COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-09",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A",
        "authorized_official_last_name": "ROCKWELL",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-310-7436",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020114000",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108142800",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "www.xxxxx.com",
            "affiliation": "N",
            "endpointDescription": "data secured online through EMR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1423 Harnden Rd W",
            "city": "Port Orange",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321297415",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "www.xxxxx.com",
            "affiliation": "N",
            "endpointDescription": "data secured online through EHR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3930 S Nova Rd Ste 303",
            "city": "Port Orange",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321279293",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Diana Choe
• Neena P Chopra, MD
• Ramesh K Chopra, MD
• William Franklin Christen, LMT
• Megan Christiansen
• Pradyumansinh M Chudasama, MD
• Noah Chudy
• Arturo Madrona Cimafranca Jr.
• Michael Antony Ciolfi, DC, HBPE,BSE
• City of Port Orange

• Mental Health Counselor in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.