Healthcare Provider Details

I. General information

NPI: 1437872132
Provider Name (Legal Business Name): HARMONIOUS HUMMINGBIRD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MARBELLA LN APT 200
SANFORD FL
32771-0187
US

IV. Provider business mailing address

701 MARBELLA LN APT 200
SANFORD FL
32771-0187
US

V. Phone/Fax

Practice location:
  • Phone: 754-399-7137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ORINTHEA DECARISH
Title or Position: OWNER/PROVIDER
Credential:
Phone: 754-399-7137