Individual
ALTAGRACE K SOUVERAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2140 N DON WICKHAM DR, CLERMONT, FL 34711-1922
(352) 394-5922
Mailing address
PO BOX 491000, LEESBURG, FL 34749-1000
(352) 315-7500
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW20568
FL
Other
Enumeration date
10/26/2022
Last updated
10/26/2022
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