Individual
MISS AUTUMN VICTORIA GRACE HAMPTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASTERS PSYCHOLOGY
Contact information
Practice address
648 CORAL TRACE BLVD, EDGEWATER, FL 32132-6942
(606) 259-6072
Mailing address
648 CORAL TRACE BLVD, EDGEWATER, FL 32132-6942
(606) 259-6072
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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