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Individual

KELLY ELIZABETH DESOUSA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, ATR

Contact information

Practice address
4282 HERSCHEL ST, JACKSONVILLE, FL 32210-2247
(094) 447-7797
Mailing address
4282 HERSCHEL ST, JACKSONVILLE, FL 32210-2247
(094) 447-7797

Taxonomy

Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
15-056
FL

Other

Enumeration date
06/22/2018
Last updated
11/17/2020
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