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General NPI Number Information
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NPI Number | 1184255929
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Entity Type | Organization
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Legal Business Name | COUNSELING SPECIALISTS, INC.
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 610 N. WYMORE RD. SUITE 110
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City | MAITLAND
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State | FL
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Zip | 32751
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Country | US
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Telephone | 321-279-0290
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Fax | 407-637-5451
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Provider Business Mailing Address
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Address Line | 610 N. WYMORE RD. SUITE 110
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City | MAITLAND
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State | FL
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Zip | 32751
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Country | US
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Telephone | 321-279-0290
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Fax | 407-637-5451
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. HEIDI MICHELLE JACKSON
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Credential | PHD, LMHC-S, RPT-S
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Telephone | 321-279-0290
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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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