Healthcare Provider Details

I. General information

NPI: 1124612502
Provider Name (Legal Business Name): KIARA CARDONA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 ALLIGATOR ST
SAINT CLOUD FL
34771-7540
US

IV. Provider business mailing address

7630 PISSARRO DR
ORLANDO FL
32819-7366
US

V. Phone/Fax

Practice location:
  • Phone: 407-433-1832
  • Fax:
Mailing address:
  • Phone: 407-204-9707
  • Fax: 407-537-3504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: