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General NPI Number Information
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NPI Number | 1598284259
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Entity Type | Organization
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Legal Business Name | FELIPE FONSECA, LLC.
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2260 GLENWOOD DR
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City | WINTER PARK
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State | FL
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Zip | 32792-3312
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Country | US
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Telephone | 845-826-0727
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Fax | 407-892-8346
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Provider Business Mailing Address
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Address Line | 4820 WINDBOURNE WAY
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City | SAINT CLOUD
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State | FL
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Zip | 34772-6858
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Country | US
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Telephone | 845-826-0727
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Fax | 407-892-8346
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | MR. BJ JOHNSON II
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Credential |
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Telephone | 845-826-0727
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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 | MH14147
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MH14147
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License Number State | FL
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