Healthcare Provider Details

I. General information

NPI: 1306131529
Provider Name (Legal Business Name): MORESA CULBREATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PARK CENTER DR STE 12
ORLANDO FL
32835-5700
US

IV. Provider business mailing address

1601 PARK CENTER DR STE 12
ORLANDO FL
32835-5700
US

V. Phone/Fax

Practice location:
  • Phone: 321-320-8472
  • Fax: 407-209-0329
Mailing address:
  • Phone: 321-320-8472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: