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General NPI Number Information
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NPI Number | 1205325297
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Entity Type | Organization
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Legal Business Name | INNER AWAKENING THERAPY CENTER LLC
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 1575 DETRICK AVE
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City | DELAND
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State | FL
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Zip | 32724-2042
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Country | US
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Telephone | 407-906-8633
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 DETRICK AVE
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City | DELAND
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State | FL
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Zip | 32724-2042
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Country | US
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Telephone | 407-906-8633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADEL M CEBALLOS-ROSARIO
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Credential | LMHC
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Telephone | 407-906-8633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | MH14780
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License Number State | FL
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