Healthcare Provider Details

I. General information

NPI: 1265967830
Provider Name (Legal Business Name): LUMINESCENCE COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SE RIVERSIDE DR
STUART FL
34994-2584
US

IV. Provider business mailing address

465 SE RIVERSIDE DR
STUART FL
34994-2584
US

V. Phone/Fax

Practice location:
  • Phone: 772-207-0716
  • Fax: 877-857-2217
Mailing address:
  • Phone: 772-207-0716
  • Fax: 877-857-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13243
License Number StateFL

VIII. Authorized Official

Name: CATHERINA POPA
Title or Position: PRESIDENT
Credential:
Phone: 772-812-7907