Provider Demographics
NPI:1578327417
Name:BALSECA, PAOLA AMADA (RMHCI)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:AMADA
Last Name:BALSECA
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 WALKERS GROVE LN
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2723
Mailing Address - Country:US
Mailing Address - Phone:407-710-8262
Mailing Address - Fax:
Practice Address - Street 1:17410 SR 50 STE 130
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8188
Practice Address - Country:US
Practice Address - Phone:689-500-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health