| Entity Name: | PAULA LOCKE, LCSW, CAP, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 19 Dec 2006 (18 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: | P06000155125 |
| FEI/EIN Number | 223949932 |
| Address: | 9470 LIVE OAK PLACE, #405, DAVIE, FL, 33324 |
| Mail Address: | 9470 LIVE OAK PLACE, #405, DAVIE, FL, 33324 |
| ZIP code: | 33324 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245469303 | 2009-07-10 | 2015-05-29 | 9470 LIVE OAK PL, SUITE 405, DAVIE, FL, 333244769, US | 4699 N STATE ROAD 7, SUITE P, LAUDERDALE LAKES, FL, 333195879, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 754-204-0312 |
| Fax | 9543021830 |
| Phone | +1 954-234-2724 |
Authorized person
| Name | MS. PAULA N LOCKE |
| Role | LICENSE CLINICAL SOCIAL WORKER |
| Phone | 7542040312 |
Taxonomy
| Taxonomy Code | 101YA0400X - Addiction (Substance Use Disorder) Counselor |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 171M00000X - Case Manager/Care Coordinator |
| License Number | 761451900 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 171M00000X - Case Manager/Care Coordinator |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 172V00000X - Community Health Worker |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001314200 |
| State | FL |
| Issuer | MEDICAID |
| Number | 761451900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 002968700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 001867700 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | DJ386A |
| State | FL |
| Name | Role |
|---|---|
| SPIEGEL & UTRERA, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| LOCKE PAULA | Director | 9470 LIVE OAK PLACE #405, DAVIE, FL, 33324 |
| Locke Paula | Director | 9470 Live Oak Place, Davie, FL, 33324 |
| Harris Christine A | Director | 5993 nw 57 Court, Tamarac, FL, 33319 |
| Name | Role | Address |
|---|---|---|
| LOCKE PAULA | President | 9470 LIVE OAK PLACE #405, DAVIE, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| Locke Rosalind | Secretary | 9470 LIVE OAK PLACE, DAVIE, FL, 33324 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09014900214 | TOTAL INTERVENTION EARLY SERVICES | EXPIRED | 2009-01-14 | 2014-12-31 | No data | 9470 LIVE OAK PLACE SUITE D-405, DAVIE, FL, 33324 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-09-04 | 9470 LIVE OAK PLACE, #405, DAVIE, FL 33324 | No data |
| CHANGE OF MAILING ADDRESS | 2007-09-04 | 9470 LIVE OAK PLACE, #405, DAVIE, FL 33324 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-03-10 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-17 |
| ANNUAL REPORT | 2015-02-27 |
| ANNUAL REPORT | 2014-04-01 |
| ANNUAL REPORT | 2013-03-24 |
| ANNUAL REPORT | 2012-02-10 |
| ANNUAL REPORT | 2011-04-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
