Healthcare Provider Details

I. General information

NPI: 1013821123
Provider Name (Legal Business Name): MARISA GOULD RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MERCY DR
ORLANDO FL
32808-5646
US

IV. Provider business mailing address

10949 MOSS PARK RD UNIT 340
ORLANDO FL
32832-5930
US

V. Phone/Fax

Practice location:
  • Phone: 321-806-9582
  • Fax:
Mailing address:
  • Phone: 321-806-9582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: