Organization
IMPACT COUNSELING AND CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRA FAIRLINE RICKETTS (OWNER)
(352) 587-2378
Entity
Organization
Contact information
Practice address
110 S APOPKA AVE, INVERNESS, FL 34452-4837
(362) 560-7027
Mailing address
110 S APOPKA AVE, INVERNESS, FL 34452-4837
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/17/2021
Last updated
11/15/2022
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