Individual
GENESIS GAMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2540 MICHIGAN AVE, KISSIMMEE, FL 34744-1933
(407) 846-5258
Mailing address
7417 KEY LARGO DR APT 1215, WINTER PARK, FL 32792-6929
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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