Healthcare Provider Details

I. General information

NPI: 1235756594
Provider Name (Legal Business Name): CASSANDRA LEMIEUX MOULTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSANDRA IRENE LEMIEUX

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 HICKORY TREE RD
SAINT CLOUD FL
34772-8906
US

IV. Provider business mailing address

19934 VILLA ISLE DR APT 107
ORLANDO FL
32821-5185
US

V. Phone/Fax

Practice location:
  • Phone: 321-805-4850
  • Fax:
Mailing address:
  • Phone: 786-344-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: