| Entity Name: | INTRACOASTAL COUNSELING CENTER SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Apr 2022 (3 years ago) |
| Document Number: | L22000170627 |
| FEI/EIN Number | 88-1969621 |
| Address: | 1604 16TH LANE, A, GREENACRES, FL 33463 |
| Mail Address: | PO BOX 7043, LAKE WORTH, FL 33466 |
| ZIP code: | 33463 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548909062 | 2022-06-02 | 2022-06-02 | 1604 16TH LN # A, GREENACRES, FL, 334634360, US | 1604 16TH LN # A, GREENACRES, FL, 334634360, US | |||||||||||||||||||||||||||||||
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| Phone | +1 561-727-9166 |
| Fax | 5612239040 |
Authorized person
| Name | MS. JODI RABKIN-TURNER |
| Role | OWNER/THERAPIST |
| Phone | 5617279166 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
| Taxonomy Code | 101YP1600X - Pastoral Counselor |
| Is Primary | No |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| Is Primary | No |
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1932563335 |
| Name | Role | Address |
|---|---|---|
| RABKIN-TURNER, JODI | Agent | 1604 16TH LANE, GREENACRES, FL 33463 |
| Name | Role | Address |
|---|---|---|
| RABKIN-TURNER, JODI | Manager | 1604 16TH LANE, GREENACRES, FL 33463 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-26 |
| Florida Limited Liability | 2022-04-08 |
Date of last update: 12 Feb 2025
Sources: Florida Department of State
