| Entity Name: | CAROL HOOPER, LCSW, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 13 May 2020 (5 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | L20000129427 |
| Address: | 9 EAST LANE, ST AUGUSTINE, FL 32084 |
| Mail Address: | 9 EAST LANE, ST AUGUSTINE, FL 32084 |
| ZIP code: | 32084 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568757458 | 2011-06-19 | 2011-06-19 | 9 EAST LN, ST AUGUSTINE, FL, 320843209, US | 9 EAST LN, ST AUGUSTINE, FL, 320843209, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 904-501-0846 |
| Fax | 9044618368 |
Authorized person
| Name | CAROL HOOPER |
| Role | OWNER/OPERATOR |
| Phone | 90450102846 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | SW5803 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | Z02UZ |
| State | FL |
| Issuer | MEDICAID |
| Number | 070860700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HOOPER, CAROL, LCSW | Agent | 9 EAST LANE, ST AUGUSTINE FL, FL 32084 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2020-05-13 |
Date of last update: 15 Feb 2025
Sources: Florida Department of State
