| Entity Name: | CLARKE COUNSELING & PSYCHOLOGICAL SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 19 Nov 2018 (6 years ago) |
| Document Number: | L18000269188 |
| FEI/EIN Number | 83-2493572 |
| Address: | 710 OAKFIELD DR, SUITE 153, BRANDON, FL 33511 |
| Mail Address: | 710 OAKFIELD DR, SUITE 153, BRANDON, FL 33511 |
| ZIP code: | 33511 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063054310 | 2019-10-08 | 2019-11-08 | 710 OAKFIELD DR STE 153, BRANDON, FL, 335114954, US | 710 OAKFIELD DR, BRANDON, FL, 335114938, US | |||||||||||||||||||||||||
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| Phone | +1 813-445-8575 |
| Fax | 8136498085 |
Authorized person
| Name | NICKEISHA K CLARKE |
| Role | PROVIDER |
| Phone | 8134458575 |
Taxonomy
| Taxonomy Code | 103TB0200X - Cognitive & Behavioral Psychologist |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1245710904 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WOOLFSON, ELIHU | Agent | 1104 NIKKI VIEW DR, BRANDON, FL 33511 |
| Name | Role | Address |
|---|---|---|
| CLARKE, NICKEISHA | Manager | 710 OAKFIELD DR SUITE 153, BRANDON, FL 33511 |
| Name | Role |
|---|---|
| CLARKE-GREGORY, INC. | Director |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000135600 | EMPOWER TO CHANGE | ACTIVE | 2023-11-04 | 2028-12-31 | No data | 710 OAKFIELD DR., ST 153, BRANDON, FL, 33511 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-04-03 |
| ANNUAL REPORT | 2021-02-21 |
| ANNUAL REPORT | 2020-03-17 |
| Florida Limited Liability | 2018-11-19 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
