Healthcare Provider Details

I. General information

NPI: 1417787151
Provider Name (Legal Business Name): GENESIS MORLABAEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 S RIDGEWOOD AVE STE 205
DAYTONA BEACH FL
32114-4927
US

IV. Provider business mailing address

143 MOONSTONE CT
PORT ORANGE FL
32129-3784
US

V. Phone/Fax

Practice location:
  • Phone: 386-747-6541
  • Fax: 866-401-6150
Mailing address:
  • Phone: 310-431-0743
  • 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:
Title or Position:
Credential:
Phone: