Palm Coast Counseling, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PALM COAST COUNSELING, LLC

Practice address

1 Hargrove Grade, Ste B-1
Palm Coast, FL 32137

Phone

(386) 643-3115

Fax

(386) 276-3474

NPI assigned

Feb 25, 2018

Last updated

Jun 15, 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

Cynthia D Hairston, LMHC

Title

Owner/Administrator

Phone

(386) 451-0684

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1519516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592179200000",
    "number": "1407357437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 WELLESLEY LN",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321647867",
            "telephone_number": "386-643-3115",
            "fax_number": "386-276-3474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HARGROVE GRADE, STE B-1",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "32137",
            "telephone_number": "386-643-3115",
            "fax_number": "386-276-3474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM COAST COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-25",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A",
        "authorized_official_last_name": "HAIRSTON",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "386-451-0684",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH12217",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010691000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.