Provider Demographics
NPI:1700428612
Name:IMAGE AND LIKENESS COUNSELING LLC
Entity Type:Organization
Organization Name:IMAGE AND LIKENESS COUNSELING LLC
Other - Org Name:IMAGE AND LIKENESS COUNSELING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LMHC, NCC
Authorized Official - Prefix:
Authorized Official - First Name:MIRELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARO-CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:407-803-4717
Mailing Address - Street 1:1035 LAKE ROGERS CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7225
Mailing Address - Country:US
Mailing Address - Phone:407-803-4717
Mailing Address - Fax:407-347-2293
Practice Address - Street 1:1950 W STATE ROAD 426 # 1003
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9145
Practice Address - Country:US
Practice Address - Phone:407-803-4717
Practice Address - Fax:407-347-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty