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General NPI Number Information
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NPI Number | 1578670501
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Entity Type | Organization
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Legal Business Name | INNOVATIVE COUNSELING EXPERIENCE
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11097 HEARTH RD
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City | SPRING HILL
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State | FL
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Zip | 34608-3704
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Country | US
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Telephone | 352-684-7665
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Fax | 352-684-7665
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Provider Business Mailing Address
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Address Line | 3448 PLAZA AVE
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City | SPRING HILL
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State | FL
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Zip | 34608-3945
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Country | US
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Telephone | 352-684-7665
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Fax | 352-684-7665
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. FERNANDA MANGO
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Credential | MA
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Telephone | 352-666-6744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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