Provider Demographics
NPI:1376378349
Name:AUTHENTIC MIND COUNSELING, LLC
Entity type:Organization
Organization Name:AUTHENTIC MIND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA-JO
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:772-201-3224
Mailing Address - Street 1:331 FERN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5028
Mailing Address - Country:US
Mailing Address - Phone:772-201-3224
Mailing Address - Fax:
Practice Address - Street 1:100 W LUCERNE CIR STE 100-R
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3763
Practice Address - Country:US
Practice Address - Phone:407-630-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health