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General NPI Number Information
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NPI Number | 1114839784
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Entity Type | Organization
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Legal Business Name | ABCTHRIVE123LLC
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Dates
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Enumeration Date | 09/19/2026
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Last Update Date | 09/19/2026
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Provider Practice Location Address
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Address Line | 3750 LAKE CENTER LOOP
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City | MOUNT DORA
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State | FL
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Zip | 32757-2211
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Country | US
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Telephone | 352-431-0705
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Fax |
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Provider Business Mailing Address
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Address Line | 72 ORANGE BLOSSOM DR
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City | EUSTIS
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State | FL
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Zip | 32726-5080
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Country | US
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Telephone | 352-431-0705
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | MR. KEVIN CARSON BARKER I
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Credential | MS,LMHC,SUPERVISION
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Telephone | 352-431-0705
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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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