Healthcare Provider Details

I. General information

NPI: 1225608557
Provider Name (Legal Business Name): EKILIBRIUM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 E JEFFERSON ST
ORLANDO FL
32803-6116
US

IV. Provider business mailing address

667 ERROL PKWY
APOPKA FL
32712-2625
US

V. Phone/Fax

Practice location:
  • Phone: 305-440-8920
  • Fax: 786-431-2573
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: GLADYS AROCHE
Title or Position: PRESIDENT
Credential: LMHC-S
Phone: 305-440-8920