| Radiance Counseling & Consulting P.l. | |
|
7747 Mitchell Blvd Ste B Trinity FL 34655-4725 | |
| (404) 941-6402 | |
| (844) 642-6304 |
| Full Name | Radiance Counseling & Consulting P.l. |
|---|---|
| Speciality | Psychologist |
| Location | 7747 Mitchell Blvd Ste B, Trinity, Florida |
| Authorized Official Name and Position | Madeline Altabe (OWNER/LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 4049416402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiance Counseling & Consulting P.l. 7747 Mitchell Blvd Ste B Trinity FL 34655-4725 Ph: () - | Radiance Counseling & Consulting P.l. 7747 Mitchell Blvd Ste B Trinity FL 34655-4725 Ph: (404) 941-6402 |
| NPI Number | 1790027399 |
|---|---|
| Provider Enumeration Date | 03/21/2013 |
| Last Update Date | 12/17/2019 |
| Certification Date | 12/17/2019 |
| Medicare PECOS PAC ID | 2264674373 |
|---|---|
| Medicare Enrollment ID | O20221017000930 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790027399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY4848 (Florida) | Primary |
| Provider Name | Madeline Altabe |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1417948993 PECOS PAC ID: 9830155118 Enrollment ID: I20221017001098 |
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