Healthcare Provider Details

I. General information

NPI: 1508671462
Provider Name (Legal Business Name): SELF-LOVE COUNSELING LLC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 CLUSTER DR
ORLANDO FL
32808-5979
US

IV. Provider business mailing address

4450 CLUSTER DR
ORLANDO FL
32808-5978
US

V. Phone/Fax

Practice location:
  • Phone: 917-484-3517
  • Fax:
Mailing address:
  • Phone: 917-484-3517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN SCHULTE
Title or Position: OWNER
Credential: RCSWI
Phone: 917-484-3517