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Individual

ALTAGRACE LINDSAY GUSTAVE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2780 SW 37TH AVE STE 206, COCONUT GROVE, FL 33133-2740
(305) 646-0112
Mailing address
1175 NE 147TH ST, NORTH MIAMI, FL 33161-2442
(786) 277-7394

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
IMH18061
101YM0800X
Mental Health Counselor
Primary
MH22040
FL

Other

Enumeration date
08/12/2021
Last updated
08/24/2023
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