Healthcare Provider Details

I. General information

NPI: 1255686630
Provider Name (Legal Business Name): FIRST STEP COUNSELING OF ORLANDO, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 S STATE ROAD 434 SUITE 1004-218
ALTAMONTE SPRINGS FL
32714-3810
US

IV. Provider business mailing address

380 S STATE ROAD 434 SUITE 1004-218
ALTAMONTE SPRINGS FL
32714-3810
US

V. Phone/Fax

Practice location:
  • Phone: 321-355-3772
  • Fax:
Mailing address:
  • Phone: 321-355-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10268
License Number StateFL

VIII. Authorized Official

Name: KRISHNA PANCHAL
Title or Position: CEO
Credential: LMHC
Phone: 407-310-8523