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General NPI Number Information
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NPI Number | 1235659616
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Entity Type | Organization
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Legal Business Name | BLUE LOTUS COUNSELING AND HOLISTIC WELLNESS, LLC
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 06/26/2017
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Provider Practice Location Address
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Address Line | 336 E COLLEGE AVE STE 200
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City | TALLAHASSEE
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State | FL
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Zip | 32301-1559
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Country | US
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Telephone | 850-491-6920
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Fax |
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Provider Business Mailing Address
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Address Line | 336 E COLLEGE AVE STE 200
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City | TALLAHASSEE
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State | FL
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Zip | 32301-1559
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | YOLANDA SMITH-ERVIN
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Credential |
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Telephone | 850-228-9861
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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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