| Entity Name: | COUNSELING CENTER OF BREVARD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 12 Feb 2014 (11 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | L14000024011 |
| FEI/EIN Number | 46-4879535 |
| Address: | 1413 S. PATRICK DR., SUITE 1, INDIAN HARBOUR BEACH, FL, 32937, US |
| Mail Address: | 1413 S. PATRICK DR., SUITE 1, INDIAN HARBOUR BEACH, FL, 32937, US |
| ZIP code: | 32937 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659806313 | 2017-05-01 | 2017-05-01 | 1413 S. PATRICK DR., SUITE 1, INDIAN HARBOUR BEACH, FL, 32937, US | 1413 S PATRICK DR, SUITE 1, INDIAN HARBOUR BEACH, FL, 329374373, US | |||||||||||||||||||||||||
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| Phone | +1 321-432-9282 |
| Fax | 3217775964 |
Authorized person
| Name | MRS. KARIN PAINTER |
| Role | LMHC |
| Phone | 3215431185 |
Taxonomy
| Taxonomy Code | 305S00000X - Point of Service |
| License Number | MH 13192 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 018561500 |
| State | FL |
| Name | Role |
|---|---|
| NORTHWEST REGISTERED AGENT LLC | Agent |
| Name | Role | Address |
|---|---|---|
| PAINTER KARIN MMRS. | Manager | 1413 S. PATRICK DR. SUITE 1, INDIAN HARBOUR BEACH, FL, 32937 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2019-01-28 | 7901 4TH STREET N,, SUITE 300, ST.PETERSBURG, FL 33702 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-01-09 |
| Florida Limited Liability | 2014-02-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
