Healthcare Provider Details

I. General information

NPI: 1588500649
Provider Name (Legal Business Name): ELIJAH GEORGE MA, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MAITLAND AVE
ALTAMONTE SPRINGS FL
32701-5417
US

IV. Provider business mailing address

320 MAITLAND AVE
ALTAMONTE SPRINGS FL
32701-5417
US

V. Phone/Fax

Practice location:
  • Phone: 407-205-8226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: