Healthcare Provider Details

I. General information

NPI: 1518788769
Provider Name (Legal Business Name): ROSS DILORETO COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 US HIGHWAY 17 STE 103
FLEMING ISLAND FL
32003-4832
US

IV. Provider business mailing address

4375 US HIGHWAY 17 STE 103
FLEMING ISLAND FL
32003-4832
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-0886
  • Fax:
Mailing address:
  • Phone: 904-269-0886
  • 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: ROSS DILORETO
Title or Position: PRESIDENT
Credential:
Phone: 904-655-8710