| Ivy Bridge Counseling, Inc. | |
|
587 E Sr 434 Unit 1021b Longwood FL 32750-5284 | |
| (407) 565-7942 | |
| (540) 566-5036 |
| Full Name | Ivy Bridge Counseling, Inc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 587 E Sr 434 Unit 1021b, Longwood, Florida |
| Authorized Official Name and Position | Renata Huewitt (OWNER, MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 9125721602 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Bridge Counseling, Inc. 2272 Wekiva Village Ln Apopka FL 32703-2511 Ph: (912) 572-1602 | Ivy Bridge Counseling, Inc. 587 E Sr 434 Unit 1021b Longwood FL 32750-5284 Ph: (407) 565-7942 |
| NPI Number | 1497483689 |
|---|---|
| Provider Enumeration Date | 08/15/2022 |
| Last Update Date | 01/31/2024 |
| Certification Date | 01/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497483689 | NPI | - | NPPES |
| 30017481030001 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
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