| Entity Name: | DOMINICA J. DEBRAUWERE LCSW, DCSW, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 19 May 2006 (19 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 02 Jun 2014 (11 years ago) |
| Document Number: | P06000069860 |
| FEI/EIN Number | 204902588 |
| Address: | 4284 Kelson Avenue, Marianna, FL, 32446, US |
| Mail Address: | 2584 Governors Court, Marianna, FL, 32446, US |
| ZIP code: | 32446 |
| County: | Jackson |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194080895 | 2012-07-09 | 2014-07-18 | 2584 GOVERNORS CT, MARIANNA, FL, 324466399, US | 4284 KELSON AVE., MARIANNA, FL, 324466399, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 850-443-9801 |
| Fax | 8508936013 |
| Fax | 8505263349 |
Authorized person
| Name | MRS. DOMINICA J. DEBRAUWERE |
| Role | THERAPIST/PRESIDENT |
| Phone | 8504439801 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | SW 3307 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | 3307 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1356423537 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| deBrauwere DOMINICA J | Agent | 2584 Governors Court, Marianna, FL, 32446 |
| Name | Role | Address |
|---|---|---|
| deBrauwere DOMINICA J | President | 4284 Kelson Avenue, Marianna, FL, 32446 |
| Name | Role | Address |
|---|---|---|
| deBrauwere John R | Vice President | 2584 Governors Court, Marianna, FL, 32446 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-16 | 4284 Kelson Avenue, Marianna, FL 32446 | No data |
| NAME CHANGE AMENDMENT | 2014-06-02 | DOMINICA J. DEBRAUWERE LCSW, DCSW, INC. | No data |
| REGISTERED AGENT NAME CHANGED | 2014-04-07 | deBrauwere, DOMINICA J | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-07 | 2584 Governors Court, Marianna, FL 32446 | No data |
| CHANGE OF MAILING ADDRESS | 2013-04-22 | 4284 Kelson Avenue, Marianna, FL 32446 | No data |
| AMENDMENT AND NAME CHANGE | 2007-08-31 | DOMINICA J. PARROTT, LCSW, DCSW, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-25 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-02-07 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-04-27 |
| ANNUAL REPORT | 2019-03-04 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-04-10 |
| ANNUAL REPORT | 2016-02-28 |
| ANNUAL REPORT | 2015-01-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
