Provider Demographics
NPI:1366956831
Name:SRB COUNSELING & CONSULTING PLLC
Entity type:Organization
Organization Name:SRB COUNSELING & CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAKEYIA
Authorized Official - Middle Name:REAUCHEAN
Authorized Official - Last Name:SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-282-9443
Mailing Address - Street 1:15757 PINES BLVD # 197
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1207
Mailing Address - Country:US
Mailing Address - Phone:954-282-9443
Mailing Address - Fax:
Practice Address - Street 1:1100 W MCNAB RD STE 104
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1116
Practice Address - Country:US
Practice Address - Phone:954-282-9443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW147011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty