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General NPI Number Information
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NPI Number | 1932754561
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Entity Type | Organization
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Legal Business Name | LAKE MARY COUNSELING
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 310 WAYMONT CT STE 100
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City | LAKE MARY
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State | FL
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Zip | 32746-3475
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Country | US
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Telephone | 407-635-1979
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Fax | 321-926-3490
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Provider Business Mailing Address
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Address Line | 536 BOTTLEBRUSH LOOP
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City | SANFORD
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State | FL
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Zip | 32771-0037
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Country | US
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Telephone | 407-416-3840
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Fax | 407-787-5352
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE HEINY
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Credential | LMHC
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Telephone | 407-416-3840
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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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