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General NPI Number Information
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NPI Number | 1902207897
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Entity Type | Organization
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Legal Business Name | PRIVATE REFLECTIONS COUNSELING, LLC
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 4623 NW 53RD AVE
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City | GAINESVILLE
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State | FL
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Zip | 32653-4857
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Country | US
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Telephone | 352-388-4121
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Fax | 888-855-8123
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Provider Business Mailing Address
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Address Line | 4623 NW 53RD AVE
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City | GAINESVILLE
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State | FL
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Zip | 32653-4857
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Country | US
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Telephone | 352-388-4121
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Fax | 888-855-8123
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Authorized Official
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Title or Position | OWNER
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Name | RACHEL CANNON GHULAMANI
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Credential | LMHC
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Telephone | 352-388-4121
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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 | 11918
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License Number State | FL
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