Individual
DECARLOS KOUVARIS SCIPPIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
226 SW PINE FOREST CT, LAKE CITY, FL 32024
(386) 344-8355
Mailing address
226 SW PINE FOREST CT, LAKE CITY, FL 32024
(386) 344-8355
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW21614
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S100-171-87-297-0
DRIVER LICENSE
FL
Enumeration date
10/07/2015
Last updated
09/19/2023
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