| Entity Name: | LESLEY D ALFONSO, LMHC, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 31 Mar 2017 (8 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | P17000029385 |
| FEI/EIN Number | 82-1062865 |
| Address: | 10406 TAFT STREET, PEMBROKE PINES, FL 33026 |
| Mail Address: | 3601 S. Longfellow Circle, Hollywood, FL 33021 |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194250639 | 2017-04-21 | 2017-04-21 | 10406 TAFT ST, PEMBROKE PINES, FL, 330262819, US | 10406 TAFT ST, PEMBROKE PINES, FL, 330262819, US | |||||||||||||||||||||||||||||||
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| Phone | +1 954-436-3880 |
| Fax | 9544363881 |
Authorized person
| Name | MS. LESLEY DENNISSE ALFONSO |
| Role | PRESIDENT |
| Phone | 9544363880 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH6643 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014019800 |
| State | FL |
| Issuer | MEDICAID |
| Number | 013846800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Alfonso, Lesley D | Agent | 3601 S. Longfellow Circle, Hollywood, FL 33021 |
| Name | Role | Address |
|---|---|---|
| ALFONSO, LESLEY D | Director | 3601 SOUTH LONGFELLOW CIRCLE, HOLLYWOOD, FL 33021 |
| Name | Role | Address |
|---|---|---|
| ALFONSO, LESLEY D | President | 3601 SOUTH LONGFELLOW CIRCLE, HOLLYWOOD, FL 33021 |
| Name | Role | Address |
|---|---|---|
| ALFONSO, LESLEY D | Secretary | 3601 SOUTH LONGFELLOW CIRCLE, HOLLYWOOD, FL 33021 |
| Name | Role | Address |
|---|---|---|
| ALFONSO, LESLEY D | Treasurer | 3601 SOUTH LONGFELLOW CIRCLE, HOLLYWOOD, FL 33021 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-19 | 10406 TAFT STREET, PEMBROKE PINES, FL 33026 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-19 | 3601 S. Longfellow Circle, Hollywood, FL 33021 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-10-15 | 10406 TAFT STREET, PEMBROKE PINES, FL 33026 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-10 | Alfonso, Lesley D | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-04-23 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-04-10 |
| Domestic Profit | 2017-03-31 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
