Organization
FELIPE FONSECA, LLC.
Active
Other names
Inner Peace Awareness Counseling, LLC.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BJ JOHNSON II (BILLING SPECIALIST)
(845) 826-0727
Entity
Organization
Contact information
Practice address
2260 GLENWOOD DR, WINTER PARK, FL 32792-3312
(845) 826-0727
(407) 892-8346
Mailing address
4820 WINDBOURNE WAY, SAINT CLOUD, FL 34772-6858
(845) 826-0727
(407) 892-8346
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
MH14147
FL
101YM0800X
Mental Health Counselor
MH14147
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020576300
—
FL
01
—
4879059
AETNA
FL
01
—
601184189
MAGELLAN
FL
01
—
QJK6X
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/13/2017
Last updated
06/16/2018
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