Healthcare Provider Details

I. General information

NPI: 1548824212
Provider Name (Legal Business Name): KAAMILAH MIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2019
Last Update Date: 04/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2479 ALOMA AVE
WINTER PARK FL
32792-2541
US

IV. Provider business mailing address

6371 PREAKNESS DR
ORLANDO FL
32818-1742
US

V. Phone/Fax

Practice location:
  • Phone: 407-657-6692
  • Fax:
Mailing address:
  • Phone: 407-501-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: