Healthcare Provider Details

I. General information

NPI: 1831485259
Provider Name (Legal Business Name): COUNSELING AND BEHAVIORAL SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W. DIXIE AVE
LEESBURG FL
34748
US

IV. Provider business mailing address

P.O. BOX 491459
LEESBURG FL
34749
US

V. Phone/Fax

Practice location:
  • Phone: 352-323-8872
  • Fax: 352-801-7376
Mailing address:
  • Phone: 352-323-8872
  • Fax: 352-801-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 6627
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-01-0570
License Number StateFL

VIII. Authorized Official

Name: MRS. KIRSTEN SKOVMAND-WILSON
Title or Position: OWNER/COUNSELOR
Credential: LMHC
Phone: 352-323-8872