| Entity Name: | WHITE SANDS COUNSELING CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Aug 2018 (6 years ago) |
| Document Number: | L18000192749 |
| FEI/EIN Number | 83-1778170 |
| Address: | 9511 Holsberry Rd, Pensacola, FL, 32534, US |
| Mail Address: | 9511 Holsberry Rd, Pensacola, FL, 32534, US |
| ZIP code: | 32534 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952874349 | 2019-01-08 | 2020-05-13 | 9511 HOLSBERRY RD STE B1, PENSACOLA, FL, 325341320, US | 9511 HOLSBERRY RD STE B1, PENSACOLA, FL, 325341320, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 850-525-2551 |
Authorized person
| Name | JOSEPH R DUTRA |
| Role | PARTNER |
| Phone | 8505252551 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1750722674 |
| State | FL |
| Issuer | MEDICARE |
| Number | HU042Y |
| State | FL |
| Issuer | MEDICAID |
| Number | 016112400 |
| State | FL |
| Issuer | BCBS PROVIDER |
| Number | 08RBR |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DUTRA JOSEPH R | Agent | 9511 Holsberry Rd, Pensacola, FL, 32534 |
| Name | Role | Address |
|---|---|---|
| DUTRA JOSEPH R | Authorized Person | 9511 Holsberry Rd, Pensacola, FL, 32534 |
| DUPRE DANETTE M | Authorized Person | 9511 Holsberry Rd, Pensacola, FL, 32534 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-01 | 9511 Holsberry Rd, Ste B1, Pensacola, FL 32534 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-01 | 9511 Holsberry Rd, Ste B1, Pensacola, FL 32534 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-01 | 9511 Holsberry Rd, Ste B1, Pensacola, FL 32534 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-04-01 |
| Florida Limited Liability | 2018-08-13 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
