Healthcare Provider Details

I. General information

NPI: 1881328433
Provider Name (Legal Business Name): YULONDA RENEE LOUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S DILLARD ST
WINTER GARDEN FL
34787-3596
US

IV. Provider business mailing address

1176 COASTAL CIR
OCOEE FL
34761-4322
US

V. Phone/Fax

Practice location:
  • Phone: 407-734-3338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW14298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: