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General NPI Number Information
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NPI Number | 1497483689
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Entity Type | Organization
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Legal Business Name | IVY BRIDGE COUNSELING, INC.
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 587 E SR 434 UNIT 1021B
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City | LONGWOOD
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State | FL
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Zip | 32750-5284
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Country | US
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Telephone | 407-565-7942
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Fax | 540-566-5036
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Provider Business Mailing Address
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Address Line | 2272 WEKIVA VILLAGE LN
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City | APOPKA
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State | FL
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Zip | 32703-2511
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Country | US
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Telephone | 912-572-1602
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Fax | 540-566-5036
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Authorized Official
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Title or Position | OWNER, MENTAL HEALTH THERAPIST
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Name | RENATA HUEWITT
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Credential | LPC
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Telephone | 912-572-1602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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