Healthcare Provider Details

I. General information

NPI: 1689111502
Provider Name (Legal Business Name): DARYL DOWDING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 ALCAIA RD.
LAKELAND FL
33801
US

IV. Provider business mailing address

390 ALCAIA RD.
LAKELAND FL
33801
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-1950
  • Fax: 863-683-4654
Mailing address:
  • Phone: 863-680-1950
  • Fax: 863-683-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5881
License Number StateFL

VIII. Authorized Official

Name: MS. DARYL DOWDING
Title or Position: OWNER
Credential: LMHC
Phone: 863-680-1950