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Organization
FSBA,INC
Active
Organization
FSBA,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN DEBORAH CLIETT LMHC (CEO)
(352) 278-1920
Entity
Organization
Contact information
Practice address
19802 OLD BELLAMY RD, ALACHUA, FL 32615-3867
(352) 278-1920
Mailing address
19802 OLD BELLAMY RD, ALACHUA, FL 32615-3867
(352) 278-1920
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH2814
FL
Other
Enumeration date
10/06/2016
Last updated
10/06/2016
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