Healthcare Provider Details

I. General information

NPI: 1801036397
Provider Name (Legal Business Name): KINDRED COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 W LAKE MARY BLVD SUITE 307
LAKE MARY FL
32746-3473
US

IV. Provider business mailing address

3525 W LAKE MARY BLVD SUITE 307
LAKE MARY FL
32746-3473
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-8018
  • Fax: 407-322-8575
Mailing address:
  • Phone: 407-322-8018
  • Fax: 407-322-8575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8982
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9137
License Number StateFL

VIII. Authorized Official

Name: MRS. NADIA HUMPHREYS
Title or Position: OWNER
Credential: LMHC
Phone: 407-322-8018