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General NPI Number Information
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NPI Number | 1356956114
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Entity Type | Organization
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Legal Business Name | CHRYSALIS COUNSELING CENTER LLC
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 3930 S NOVA RD STE 303
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City | PORT ORANGE
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State | FL
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Zip | 32127-9293
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Country | US
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Telephone | 386-310-7436
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Fax | 386-259-6112
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Provider Business Mailing Address
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Address Line | 3930 S NOVA RD STE 303
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City | PORT ORANGE
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State | FL
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Zip | 32127-9293
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Country | US
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Telephone | 386-310-7436
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Fax | 386-259-6112
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Authorized Official
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Title or Position | OWNER
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Name | MS. BRENDA C ROCKWELL
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Credential | LMHC
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Telephone | 386-310-7436
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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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