Individual
ADELLE ALTIDOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
525 NW LAKE WHITNEY PL, SUITES #102/103, PORT ST LUCIE, FL 34986-1605
(772) 337-8164
(772) 337-8165
Mailing address
525 NW LAKE WHITNEY PL, SUITES # 102/103, PORT ST LUCIE, FL 34986-1605
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A433-000-81-722-1
DRIVERS LICENSE
FL
Enumeration date
09/17/2015
Last updated
09/17/2015
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