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Organization
THE ECOTHERAPY PLACE LLC
Active
Organization
THE ECOTHERAPY PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTIANE FERNANDES LCSW (CLINICIAN)
(239) 895-6954
Entity
Organization
Contact information
Practice address
18320 PERSIMMON RIDGE RD, ALVA, FL 33920-2037
(239) 895-6954
Mailing address
PO BOX 2037, ALVA, FL 33920-2037
(239) 895-6954
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111229900
—
FL
05
—
114247300
—
FL
Enumeration date
04/15/2022
Last updated
10/13/2022
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