Healthcare Provider Details

I. General information

NPI: 1134793094
Provider Name (Legal Business Name): LIFE IN FULL BLOOM COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTHALL LN STE 133
MAITLAND FL
32751-4195
US

IV. Provider business mailing address

2700 WESTHALL LN STE 133
MAITLAND FL
32751-4195
US

V. Phone/Fax

Practice location:
  • Phone: 407-513-2589
  • Fax: 407-637-2823
Mailing address:
  • Phone: 407-513-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY VALENCE
Title or Position: LMHC
Credential:
Phone: 407-513-2589