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General NPI Number Information
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NPI Number | 1629883665
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Entity Type | Organization
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Legal Business Name | ELYSIAN LIFE COACHING AND COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 340 W CENTRAL AVE STE 330
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City | WINTER HAVEN
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State | FL
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Zip | 33880-2967
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Country | US
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Telephone | 863-266-6024
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Fax |
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Provider Business Mailing Address
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Address Line | 340 W CENTRAL AVE STE 330
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City | WINTER HAVEN
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State | FL
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Zip | 33880-2967
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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 | LCSW INTERN
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Name | MRS. KENYA COATES CHARLES
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Credential | LCSW INTERN
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Telephone | 863-266-6024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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