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General NPI Number Information
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NPI Number | 1568869535
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Entity Type | Individual
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Provider Name | RACHEL DESTEFANO
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Gender | Female
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 4300 DUHME RD
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City | MADEIRA BEACH
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State | FL
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Zip | 33708-2892
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Country | US
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Telephone | 877-566-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 SW 13TH ST
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City | GAINESVILLE
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State | FL
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Zip | 32608-4006
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Country | US
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Telephone |
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Fax |
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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 | MH14837
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License Number State | FL
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