Healthcare Provider Details

I. General information

NPI: 1235996661
Provider Name (Legal Business Name): REPLENISH COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N BEACH ST STE 200
DAYTONA BEACH FL
32114-3307
US

IV. Provider business mailing address

206 N BEACH ST STE 200
DAYTONA BEACH FL
32114-3307
US

V. Phone/Fax

Practice location:
  • Phone: 407-603-1677
  • Fax:
Mailing address:
  • Phone: 407-603-1677
  • 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: FRANCESCA COOK
Title or Position: OWNER
Credential: LMHC
Phone: 407-603-1677