Healthcare Provider Details

I. General information

NPI: 1740874155
Provider Name (Legal Business Name): PEACE WITHIN: COUNSELING FOR WOMEN, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9451 MERRIFIELD ST UNIT A
ORLANDO FL
32827-3847
US

IV. Provider business mailing address

9451 MERRIFIELD ST UNIT A
ORLANDO FL
32827-3847
US

V. Phone/Fax

Practice location:
  • Phone: 407-205-2959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE RIVERA-CLONCH
Title or Position: OWNER
Credential: PHD
Phone: 407-797-5708