| Entity Name: | COUNSELING & DISABILITY SERVICES, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 May 2012 (13 years ago) |
| Document Number: | L12000066011 |
| FEI/EIN Number | 45-5326612 |
| Address: | 1635 S Ridgewood Avenue, SOUTH DAYTONA, FL, 32119, US |
| Mail Address: | 1635 S Ridgewood Avenue, SOUTH DAYTONA, FL, 32119, US |
| ZIP code: | 32119 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518205152 | 2013-01-16 | 2024-05-13 | 1635 S RIDGEWOOD AVE STE 225, SOUTH DAYTONA, FL, 321198478, US | 1635 S RIDGEWOOD AVE STE 225, SOUTH DAYTONA, FL, 321198478, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-788-5021 |
| Fax | 3867885021 |
Authorized person
| Name | PHYLLIS LAVIGNA |
| Role | OWNER/LCSW |
| Phone | 3867885021 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
| Taxonomy Code | 251B00000X - Case Management Agency |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | SW9461 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 013190700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 013191700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LAVIGNA PHYLLIS A | Agent | 116 SNOW GOOSE COURT, DAYTONA BEACH, FL, 32119 |
| Name | Role | Address |
|---|---|---|
| LAVIGNA PHYLLIS A | Manager | 116 SNOW GOOSE COURT, DAYTONA BEACH, FL, 32119 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-03-29 | 1635 S Ridgewood Avenue, Suite #225, SOUTH DAYTONA, FL 32119 | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-29 | 1635 S Ridgewood Avenue, Suite #225, SOUTH DAYTONA, FL 32119 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-11 |
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-03-27 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2020-03-01 |
| ANNUAL REPORT | 2019-05-04 |
| ANNUAL REPORT | 2018-03-29 |
| ANNUAL REPORT | 2017-03-23 |
| ANNUAL REPORT | 2016-04-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
