Healthcare Provider Details

I. General information

NPI: 1215810387
Provider Name (Legal Business Name): GLORIOUS HANDS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W 9TH ST
SANFORD FL
32771-2401
US

IV. Provider business mailing address

609 W 9TH ST
SANFORD FL
32771-2401
US

V. Phone/Fax

Practice location:
  • Phone: 407-474-4864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: KEMEDONTAE BROWN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 407-474-4864