Healthcare Provider Details

I. General information

NPI: 1548683709
Provider Name (Legal Business Name): GINA COBARRIS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W SOUTH ST
ORLANDO FL
32805-2322
US

IV. Provider business mailing address

3300 W SOUTH ST
ORLANDO FL
32805-2322
US

V. Phone/Fax

Practice location:
  • Phone: 407-963-3599
  • Fax:
Mailing address:
  • Phone: 407-963-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMT1963
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberIMT1963
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT1963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: