Healthcare Provider Details

I. General information

NPI: 1356500706
Provider Name (Legal Business Name): KACHELL DEOND GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KACHELL D LAWRENCE

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 1ST ST S
WINTER HAVEN FL
33880-3904
US

IV. Provider business mailing address

1201 1ST ST S
WINTER HAVEN FL
33880-3904
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-7062
  • Fax: 863-291-6755
Mailing address:
  • Phone: 863-294-7062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: