Individual
CHANICE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED, NCC
Contact information
Practice address
3577 SW CORPORATE PKWY, PALM CITY, FL 34990-8153
(772) 220-3439
Mailing address
261 BRAZILIAN CIR, PORT ST LUCIE, FL 34952-1398
(646) 610-3538
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
IMH17666
FL
Other
Enumeration date
11/27/2018
Last updated
11/27/2018
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