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General NPI Number Information
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NPI Number | 1487368569
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Entity Type | Organization
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Legal Business Name | LEAD,EMPOWERED,SET,MENTAL HEALTH SERVICES,LLC
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 6925 LAKE ELLENOR DR STE 120
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City | ORLANDO
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State | FL
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Zip | 32809-4648
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Country | US
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Telephone | 407-552-5444
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Fax |
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Provider Business Mailing Address
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Address Line | 6925 LAKE ELLENOR DR STE 120
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City | ORLANDO
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State | FL
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Zip | 32809-4648
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Country | US
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Telephone | 407-552-5444
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DIANA ABRIL MEDINA
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Credential | LMHC
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Telephone | 407-301-1845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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