Healthcare Provider Details

I. General information

NPI: 1750150892
Provider Name (Legal Business Name): BELLA INNOCENT RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 HAMLIN AVE UNIT G
SAINT CLOUD FL
34771-8590
US

IV. Provider business mailing address

3312 KALEIGH CT
SAINT CLOUD FL
34772-7054
US

V. Phone/Fax

Practice location:
  • Phone: 321-344-0043
  • Fax:
Mailing address:
  • Phone: 516-282-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: