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General NPI Number Information
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NPI Number | 1912362005
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Entity Type | Organization
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Legal Business Name | NORTH EAST ORLANDO COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 04/28/2018
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Provider Practice Location Address
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Address Line | 2500 W LAKE MARY BLVD STE 107
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City | LAKE MARY
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State | FL
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Zip | 32746-3501
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Country | US
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Telephone | 407-782-5092
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Fax | 267-295-1929
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Provider Business Mailing Address
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Address Line | 2500 W LAKE MARY BLVD STE 107
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City | LAKE MARY
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State | FL
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Zip | 32746-3501
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Country | US
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Telephone | 407-782-5092
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Fax | 267-295-1929
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DIANE P SNOW
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Credential | LCSW
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Telephone | 407-782-5092
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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 | SW12409
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License Number State | FL
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