Organization
INNOVATIVE COUNSELING EXPERIENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FERNANDA MANGO MA (PRESIDENT)
(352) 666-6744
Entity
Organization
Contact information
Practice address
11097 HEARTH RD, SPRING HILL, FL 34608-3704
(352) 684-7665
(352) 684-7665
Mailing address
3448 PLAZA AVE, SPRING HILL, FL 34608-3945
(352) 684-7665
(352) 684-7665
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/24/2006
Last updated
08/22/2020
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