Healthcare Provider Details

I. General information

NPI: 1245513530
Provider Name (Legal Business Name): KRISTINE M CUELLAR LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 HOLCOMB BRIDGE RD STE 100
PEACHTREE CORNERS GA
30092-2292
US

IV. Provider business mailing address

13411 GREENPOINTE DR
ORLANDO FL
32824-6295
US

V. Phone/Fax

Practice location:
  • Phone: 855-850-0274
  • Fax:
Mailing address:
  • Phone: 407-202-2768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12405
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: