Individual
JESSICA SALAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
306 E OAK ST, KISSIMMEE, FL 34744-4537
(407) 933-8331
Mailing address
306 E OAK ST, KISSIMMEE, FL 34744-4537
(407) 933-8331
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YA0400X
—
FL
Enumeration date
04/19/2018
Last updated
04/19/2018
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