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General NPI Number Information
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NPI Number | 1538295860
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Entity Type | Organization
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Legal Business Name | WEST ORANGE COUNSELING LLC
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 301 N TUBB ST
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City | OAKLAND
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State | FL
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Zip | 34760-1225
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Country | US
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Telephone | 407-877-8074
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Fax | 407-877-0410
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Provider Business Mailing Address
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Address Line | PO BOX 1225 301 N TUBB ST
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City | OAKLAND
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State | FL
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Zip | 34760-1225
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Country | US
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Telephone | 407-877-8074
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Fax | 407-877-0410
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEFFREY DAVID GILL
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Credential | LCSW
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Telephone | 407-877-8074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | SW3983
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW3983
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License Number State | FL
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