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Organization
VITALITY KIDS COUNSELING GROUP
Active
Organization
VITALITY KIDS COUNSELING GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDEL MIRANDA AUTHORIZED OFFICIAL (PRESIDENT)
(786) 384-0799
Entity
Organization
Contact information
Practice address
229 DEL PRADO BLVD N STE 9, CAPE CORAL, FL 33909-2266
(786) 384-0799
Mailing address
229 DEL PRADO BLVD N STE 9, CAPE CORAL, FL 33909-2266
(786) 384-0799
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BT21-90373
LICENSE
—
Enumeration date
04/14/2021
Last updated
04/14/2021
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