Healthcare Provider Details

I. General information

NPI: 1114839784
Provider Name (Legal Business Name): ABCTHRIVE123LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 LAKE CENTER LOOP
MOUNT DORA FL
32757-2211
US

IV. Provider business mailing address

72 ORANGE BLOSSOM DR
EUSTIS FL
32726-5080
US

V. Phone/Fax

Practice location:
  • Phone: 352-431-0705
  • Fax:
Mailing address:
  • Phone: 352-431-0705
  • 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: MR. KEVIN CARSON BARKER I
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: MS,LMHC,SUPERVISION
Phone: 352-431-0705