| Entity Name: | SUNSHINE STATE COUNSELING CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Jan 2015 (10 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 04 May 2020 (5 years ago) |
| Document Number: | L15000014062 |
| FEI/EIN Number | 47-2911615 |
| Address: | 3575 BONITA BEACH ROAD, BONITA SPRINGS, FL, 34134, US |
| Mail Address: | 3575 BONITA BEACH ROAD, BONITA SPRINGS, FL, 34134, US |
| ZIP code: | 34134 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962855668 | 2016-07-18 | 2023-12-27 | 3575 BONITA BEACH RD STE 1, BONITA SPRINGS, FL, 341344105, US | 3575 BONITA BEACH RD STE 1, BONITA SPRINGS, FL, 341344105, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 239-495-7722 |
| Fax | 2394434577 |
Authorized person
| Name | DIANA MILENA SALAZAR |
| Role | OWNER |
| Phone | 2394957722 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | SW12686 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1163217 |
| State | FL |
| Issuer | MEDICAID |
| Number | 014047700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1117901 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SALAZAR DIANA | Agent | 3575 BONITA BEACH ROAD, BONITA SPRINGS, FL, 34134 |
| Name | Role | Address |
|---|---|---|
| Salazar Diana M | Chief Executive Officer | 12521 STONE TOWER LOOP, Fort Myers, FL, 33913 |
| Name | Role | Address |
|---|---|---|
| Ariza Andres E | Chief Financial Officer | 3575 BONITA BEACH ROAD, BONITA SPRINGS, FL, 34134 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2020-05-04 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-05-04 | 3575 BONITA BEACH ROAD, SUITE 102, BONITA SPRINGS, FL 34134 | No data |
| CHANGE OF MAILING ADDRESS | 2020-05-04 | 3575 BONITA BEACH ROAD, SUITE 102, BONITA SPRINGS, FL 34134 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-05-04 | SALAZAR, DIANA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-03-25 | 3575 BONITA BEACH ROAD, SUITE 102, BONITA SPRINGS, FL 34134 | No data |
| LC AMENDMENT | 2016-07-15 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-15 |
| ANNUAL REPORT | 2024-01-16 |
| ANNUAL REPORT | 2023-02-08 |
| ANNUAL REPORT | 2022-01-20 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-06-08 |
| LC Amendment | 2020-05-04 |
| ANNUAL REPORT | 2019-04-12 |
| ANNUAL REPORT | 2018-04-02 |
| ANNUAL REPORT | 2017-03-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
