Individual
ANGELA DIAZ-VIDAILLET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
65 NW 107TH ST, MIAMI SHORES, FL 33168-4306
(305) 542-4128
Mailing address
65 NW 107TH ST, MIAMI SHORES, FL 33168-4306
(305) 542-4128
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH2353
FL
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
12/09/2021
Last updated
12/09/2021
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