| Entity Name: | PATRICIA ADAMS COUNSELING LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Dec 2014 (10 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 30 Aug 2017 (7 years ago) |
| Document Number: | L14000187149 |
| FEI/EIN Number | 47-2483953 |
| Address: | 900 N. SWALLOWTAIL DRIVE, SUITE 105, PORT ORANGE, FL 32129 |
| Mail Address: | 900 N. SWALLOWTAIL DRIVE, SUITE 105, PORT ORANGE, FL 32129 |
| ZIP code: | 32129 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578951596 | 2014-12-29 | 2022-03-07 | 900 N SWALLOW TAIL DR STE 105, PORT ORANGE, FL, 321296103, US | 900 N SWALLOW TAIL DR STE 105, PORT ORANGE, FL, 321296103, US | |||||||||||||||||||||||||||||||
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| Phone | +1 386-333-9717 |
| Fax | 3863339718 |
Authorized person
| Name | MRS. PATRICIA ADAMS |
| Role | OWNER |
| Phone | 3863339717 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
Other Provider Identifiers
| Issuer | 07 - MEDICAID |
| Number | 0213714-00 |
| State | FL |
| Issuer | MEDICAID |
| Number | 0222423-00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ADAMS, PATRICIA A | Agent | 900 N. SWALLOWTAIL DRIVE, SUITE 105, PORT ORANGE, FL 32129 |
| Name | Role | Address |
|---|---|---|
| ADAMS, PATRICIA | Manager | 900 N. SWALLOWTAIL DRIVE, SUITE 105 PORT ORANGE, FL 32129 |
| ADAMS, RAYMOND | Manager | 900 N. SWALLOWTAIL DRIVE, SUITE 105 PORT ORANGE, FL 32129 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000068097 | LAKESIDE COUNSELING AND WELLNESS CENTER | ACTIVE | 2017-06-21 | 2027-12-31 | No data | 900 N SWALLOWTAIL DR, STE 105, PORT ORANGE, FL, 32129 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2017-08-30 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-08-30 | 900 N. SWALLOWTAIL DRIVE, SUITE 105, PORT ORANGE, FL 32129 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-08-25 | 900 N. SWALLOWTAIL DRIVE, SUITE 105, PORT ORANGE, FL 32129 | No data |
| CHANGE OF MAILING ADDRESS | 2017-08-25 | 900 N. SWALLOWTAIL DRIVE, SUITE 105, PORT ORANGE, FL 32129 | No data |
| LC STMNT CORR | 2014-12-19 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-22 |
| ANNUAL REPORT | 2023-01-12 |
| ANNUAL REPORT | 2022-01-25 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-08 |
| ANNUAL REPORT | 2019-06-13 |
| ANNUAL REPORT | 2018-02-19 |
| LC Amendment | 2017-08-30 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-15 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
