Individual
KEIRON TIMOTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
804 N WOODLAND BLVD, DELAND, FL 32720-2709
(386) 734-7571
(386) 734-0252
Mailing address
804 N WOODLAND BLVD, DELAND, FL 32720-2709
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1326075300
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070525000
—
FL
Enumeration date
08/21/2012
Last updated
08/21/2012
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