Provider Demographics
NPI:1275038416
Name:INNER GROWTH COUNSELING LLC
Entity Type:Organization
Organization Name:INNER GROWTH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC MH12067
Authorized Official - Phone:407-233-1866
Mailing Address - Street 1:13574 VILLAGE PARK DR STE 240
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7695
Mailing Address - Country:US
Mailing Address - Phone:407-233-1866
Mailing Address - Fax:
Practice Address - Street 1:13574 VILLAGE PARK DR STE 240
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7695
Practice Address - Country:US
Practice Address - Phone:407-233-1866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12067261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID