Healthcare Provider Details

I. General information

NPI: 1154446110
Provider Name (Legal Business Name): COUNSELING CORNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 HILLCREST ST
ORLANDO FL
32803-4810
US

IV. Provider business mailing address

1630 HILLCREST ST
ORLANDO FL
32803-4810
US

V. Phone/Fax

Practice location:
  • Phone: 407-843-4968
  • Fax: 407-447-4543
Mailing address:
  • Phone: 407-843-4968
  • Fax: 407-447-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5067
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5041
License Number StateFL

VIII. Authorized Official

Name: MR. ERNEST W REILLY
Title or Position: DIRECTOR
Credential: MSW, LCSW
Phone: 407-843-4968