Individual
MS. ALICE POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
602 MELTON AVE, AUBURNDALE, FL 33823-4428
(863) 967-8190
(863) 967-8192
Mailing address
12409 CEDARFIELD DR, RIVERVIEW, FL 33579-9702
(407) 307-9776
(863) 967-8192
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
120247
FL
324500000X
Substance Abuse Rehabilitation Facility
4655
FL
Other
Enumeration date
05/10/2018
Last updated
05/10/2018
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