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General NPI Number Information
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NPI Number | 1457661787
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Entity Type | Individual
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Provider Name | MELITA COGBURN B.S., M.A., LMHC
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Gender | Female
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 02/12/2022
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Provider Practice Location Address
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Address Line | 5749 WESTGATE DR STE 102
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City | ORLANDO
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State | FL
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Zip | 32835-5040
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Country | US
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Telephone | 407-340-8619
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Fax | 517-000-0000
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Provider Business Mailing Address
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Address Line | 1141 PEPPERDINE LN
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City | SANFORD
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State | FL
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Zip | 32771-6646
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Country | US
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Telephone | 407-435-4711
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Fax | 517-000-0000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 19743
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License Number State | FL
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