Healthcare Provider Details

I. General information

NPI: 1407447980
Provider Name (Legal Business Name): DBT ORLANDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 DOUGLAS AVE STE 107
ALTAMONTE SPRINGS FL
32714-5205
US

IV. Provider business mailing address

711 N ORLANDO AVE STE 203A
MAITLAND FL
32751-4403
US

V. Phone/Fax

Practice location:
  • Phone: 321-417-7299
  • Fax:
Mailing address:
  • Phone: 407-754-6967
  • 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: MARIBEL J RODRIGUEZ
Title or Position: COUNSELOR / OWNER
Credential: LMCH
Phone: 407-754-6967