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General NPI Number Information
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NPI Number | 1700428612
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Entity Type | Organization
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Legal Business Name | IMAGE AND LIKENESS COUNSELING LLC
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Dates
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Enumeration Date | 10/11/2019
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1950 W STATE ROAD 426 # 1003
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City | OVIEDO
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State | FL
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Zip | 32765-9145
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Country | US
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Telephone | 407-803-4717
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Fax | 407-347-2293
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Provider Business Mailing Address
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Address Line | 1035 LAKE ROGERS CIR
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City | OVIEDO
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State | FL
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Zip | 32765-7225
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Country | US
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Telephone | 407-803-4717
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Fax | 407-347-2293
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Authorized Official
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Title or Position | LMHC, NCC
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Name | MIRELLA CARO-CORTES
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Credential | MS
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Telephone | 407-803-4717
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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 |
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License Number State |
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