Provider Demographics
NPI:1790027399
Name:RADIANCE COUNSELING & CONSULTING P.L.
Entity Type:Organization
Organization Name:RADIANCE COUNSELING & CONSULTING P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTABE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-941-6402
Mailing Address - Street 1:7747 MITCHELL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7747 MITCHELL BLVD STE B
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4725
Practice Address - Country:US
Practice Address - Phone:404-941-6402
Practice Address - Fax:844-642-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4848103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty