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612 E Colonial Dr Ste 390 Orlando FL 32803-4650 | |
| (321) 441-6038 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 612 E Colonial Dr Ste 390, Orlando, Florida |
| Authorized Official Name and Position | Peter Craig Rivkees (PRESIDENT) |
| Authorized Official Contact | 3214416038 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 3402 Winter Park FL 32790-3402 Ph: () - | 612 E Colonial Dr Ste 390 Orlando FL 32803-4650 Ph: (321) 441-6038 |
| NPI Number | 1316299373 |
|---|---|
| Provider Enumeration Date | 10/15/2012 |
| Last Update Date | 03/14/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316299373 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | IMH10426 (Florida) | Primary |
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