Healthcare Provider Details

I. General information

NPI: 1790388221
Provider Name (Legal Business Name): OHANA COUNSELING & WELLNESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 INTERNATIONAL PKWY
LAKE MARY FL
32746-5096
US

IV. Provider business mailing address

5540 WILSON RD
SANFORD FL
32771-8669
US

V. Phone/Fax

Practice location:
  • Phone: 407-603-5636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMANDA METCALF
Title or Position: OWNER
Credential: LMHC, CLC, MA
Phone: 407-603-5636