Healthcare Provider Details

I. General information

NPI: 1790027399
Provider Name (Legal Business Name): RADIANCE COUNSELING & CONSULTING P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7747 MITCHELL BLVD STE B
TRINITY FL
34655-4725
US

IV. Provider business mailing address

7747 MITCHELL BLVD STE B
TRINITY FL
34655-4725
US

V. Phone/Fax

Practice location:
  • Phone: 404-941-6402
  • Fax: 844-642-6304
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY4848
License Number StateFL

VIII. Authorized Official

Name: DR. MADELINE ALTABE
Title or Position: OWNER/LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 404-941-6402