Healthcare Provider Details

I. General information

NPI: 1093172389
Provider Name (Legal Business Name): CONNECTING WELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5728 MAJOR BLVD STE 506
ORLANDO FL
32819-7970
US

IV. Provider business mailing address

8654 VISTA PINE CT
ORLANDO FL
32836-6307
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-1010
  • Fax:
Mailing address:
  • Phone: 407-351-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH2413
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT959
License Number StateFL

VIII. Authorized Official

Name: NANCY LANGFORD
Title or Position: PRESIDENT
Credential: M.ED.
Phone: 407-351-1010