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Organization
INTEGRATED LIFE COUNSELING AND BEHAVIOR SERVICES
Active
Organization
INTEGRATED LIFE COUNSELING AND BEHAVIOR SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANACAROLINA VAUGHN LMHC (OWNER)
(321) 848-1916
Entity
Organization
Contact information
Practice address
200 WAYMONT CT STE 126-10, LAKE MARY, FL 32746-3413
(407) 488-7927
(407) 603-0414
Mailing address
1175 2ND PL, LONGWOOD, FL 32750-3029
(321) 848-1916
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021251000
39- MEDICAID
FL
Enumeration date
02/22/2019
Last updated
10/20/2021
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