Healthcare Provider Details

I. General information

NPI: 1578481636
Provider Name (Legal Business Name): JULIANA GAMBA MA, RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 S VOLUSIA AVE STE B4
ORANGE CITY FL
32763-7625
US

IV. Provider business mailing address

614 FENTON PL UNIT 203
ALTAMONTE SPRINGS FL
32701-6912
US

V. Phone/Fax

Practice location:
  • Phone: 321-578-7488
  • Fax:
Mailing address:
  • Phone: 603-820-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: