Organization
FIVESHINE CORPORATION
Active
Other names
Ellie Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE E OLOFSON (PRESIDENT)
(407) 928-1425
Entity
Organization
Contact information
Practice address
3680 AVALON PARK EAST BLVD STE 301, ORLANDO, FL 32828-9372
(407) 928-1425
Mailing address
11506 BRIGHTSTOWE WAY, ORLANDO, FL 32836-8844
(407) 758-9959
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/18/2024
Last updated
06/18/2024
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