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General NPI Number Information
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NPI Number | 1104631902
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Entity Type | Organization
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Legal Business Name | DR STEVIE
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 6810 LYONS TECHNOLOGY CIR STE 170
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4322
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Country | US
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Telephone | 549-515-9899
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Fax |
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Provider Business Mailing Address
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Address Line | 6810 LYONS TECHNOLOGY CIR STE 170
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4322
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Country | US
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Telephone | 727-385-7565
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARA S PENA
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Credential |
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Telephone | 727-385-7565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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