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General NPI Number Information
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NPI Number | 1508638974
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Entity Type | Organization
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Legal Business Name | LATORRE COUNSELING CENTER CO
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Dates
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Enumeration Date | 10/27/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 11512 LAKE MEAD AVE UNIT 405
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9687
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Country | US
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Telephone | 904-479-5863
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Fax |
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Provider Business Mailing Address
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Address Line | 11512 LAKE MEAD AVE UNIT 405
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9687
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Country | US
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Telephone | 904-479-5863
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GABRIELLE LATORRE
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Credential |
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Telephone | 904-479-5863
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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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