Healthcare Provider Details

I. General information

NPI: 1295549814
Provider Name (Legal Business Name): EDEN WELLNESS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W CENTRAL PKWY
ALTAMONTE SPRINGS FL
32714-2415
US

IV. Provider business mailing address

1015 ARTHUR AVE
ORLANDO FL
32804-2826
US

V. Phone/Fax

Practice location:
  • Phone: 407-545-2413
  • Fax:
Mailing address:
  • Phone: 407-545-2413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RYAN J FONTAINE
Title or Position: OWNER
Credential: LMHC
Phone: 407-739-5561