Individual
BANALY BLAISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
8430 ROSE GROVES RD, ORLANDO, FL 32818-5689
(407) 859-2882
Mailing address
8430 ROSE GROVES RD, ORLANDO, FL 32818-5689
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
03/07/2017
Last updated
04/06/2021
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