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General NPI Number Information
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NPI Number | 1831434489
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL COUNSELING LLC
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Dates
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Enumeration Date | 12/09/2012
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 2200 E IRLO BRONSON MEMORIAL HWY 102
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City | KISSIMMEE
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State | FL
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Zip | 34744-4424
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Country | US
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Telephone | 321-442-6665
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 E IRLO BRONSON MEMORIAL HWY 102
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City | KISSIMMEE
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State | FL
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Zip | 34744-4424
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Country | US
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Telephone | 321-442-6665
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | MRS. ALICIA CARMEN OLIVARES
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Credential | LMHC
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Telephone | 321-442-6665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH11233
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License Number State | FL
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