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General NPI Number Information
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NPI Number | 1265144018
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Entity Type | Organization
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Legal Business Name | TERRA COUNSELING CENTER
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 1450 CORAL WAY STE 6
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City | MIAMI
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State | FL
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Zip | 33145-2856
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Country | US
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Telephone | 786-393-4680
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Fax |
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Provider Business Mailing Address
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Address Line | 2323 SW 11TH TER
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City | MIAMI
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State | FL
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Zip | 33135-5008
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Country | US
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Telephone | 786-393-4680
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANGELIQUE ALONSO
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Credential | PH.D.
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Telephone | 786-393-4680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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