Healthcare Provider Details

I. General information

NPI: 1649019472
Provider Name (Legal Business Name): SELF REFLECTIONS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 FRIDAY RD
COCOA FL
32926-3317
US

IV. Provider business mailing address

414 DRYDEN CIR
COCOA FL
32926-2484
US

V. Phone/Fax

Practice location:
  • Phone: 321-961-4578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DEBRA MATTHEWS-ROBINSON
Title or Position: CEO
Credential:
Phone: 321-961-4578