Healthcare Provider Details

I. General information

NPI: 1851652853
Provider Name (Legal Business Name): DAMITA AUTRECIA HARTZ AP, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 NW 43RD ST STE 1B
GAINESVILLE FL
32606-6677
US

IV. Provider business mailing address

2610 NW 43RD ST STE 1B
GAINESVILLE FL
32606-6677
US

V. Phone/Fax

Practice location:
  • Phone: 352-448-5836
  • Fax: 352-448-7789
Mailing address:
  • Phone: 352-448-5836
  • Fax: 352-448-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4015
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: