Healthcare Provider Details

I. General information

NPI: 1205740107
Provider Name (Legal Business Name): THE HEALING GARDEN COUNSELING COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6906 REVERIE PARK AVE
ORLANDO FL
32829-3018
US

IV. Provider business mailing address

6906 REVERIE PARK AVE
ORLANDO FL
32829-3018
US

V. Phone/Fax

Practice location:
  • Phone: 321-287-8909
  • Fax:
Mailing address:
  • Phone: 321-287-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSALYN PEREZ
Title or Position: OWNER
Credential: LMHC
Phone: 321-287-8909