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General NPI Number Information
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NPI Number | 1730570417
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Entity Type | Organization
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Legal Business Name | AEJ LLC
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 924 N MAGNOLIA AVE
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City | ORLANDO
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State | FL
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Zip | 32803-3852
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Country | US
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Telephone | 407-312-7383
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Fax |
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Provider Business Mailing Address
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Address Line | 161 S LAKEMONT AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-4140
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Country | US
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Telephone | 407-312-7383
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADALHEIDUR ELVA JONSDOTTIR
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Credential | LMHC
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Telephone | 407-312-7383
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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 | MH 10457
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License Number State | FL
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