Organization
CHRYSALIS COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRENDA C ROCKWELL LMHC (OWNER)
(386) 310-7436
Entity
Organization
Contact information
Practice address
3930 S NOVA RD STE 303, PORT ORANGE, FL 32127-9293
(386) 310-7436
(386) 259-6112
Mailing address
3930 S NOVA RD STE 303, PORT ORANGE, FL 32127-9293
(386) 310-7436
(386) 259-6112
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020114000
—
FL
05
—
108142800
—
FL
Enumeration date
09/09/2020
Last updated
12/18/2020
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