Healthcare Provider Details

I. General information

NPI: 1952669319
Provider Name (Legal Business Name): COLETTA GARRAWAY-DONOVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTHALL LN STE 207
MAITLAND FL
32751
US

IV. Provider business mailing address

732 MARION OAKS MNR
OCALA FL
34473-5408
US

V. Phone/Fax

Practice location:
  • Phone: 880-084-0252
  • Fax:
Mailing address:
  • Phone: 718-813-7359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH9226
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number939954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: