Healthcare Provider Details

I. General information

NPI: 1225414162
Provider Name (Legal Business Name): TESHIA DENISE ECHOLS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 MAITLAND CENTER COMMONS BLVD #212
MAITLAND FL
32751-7270
US

IV. Provider business mailing address

35224 SARAH LYNN DR APT 103
DADE CITY FL
33525-8476
US

V. Phone/Fax

Practice location:
  • Phone: 407-636-3532
  • Fax:
Mailing address:
  • Phone: 850-570-9961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: