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General NPI Number Information
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NPI Number | 1336408731
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Entity Type | Organization
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Legal Business Name | MINDFUL SOLUTIONS COUNSELING SERVICES
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 1633 VILLAGE CENTER DR SUITE 306
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City | LAKELAND
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State | FL
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Zip | 33803-2870
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Country | US
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Telephone | 860-303-6827
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Fax | 863-937-4304
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Provider Business Mailing Address
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Address Line | 1633 VILLAGE CENTER DR SUITE 306
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City | LAKELAND
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State | FL
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Zip | 33803-2870
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Country | US
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Telephone | 860-303-6827
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Fax | 860-303-6827
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. DAVID ANDREW HERNANDEZ
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Credential | L.C.S.W.
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Telephone | 860-303-6827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 10505
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License Number State | FL
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