Individual
MRS. NABUCHI GRACE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHC
Contact information
Practice address
15508 WILLET CT, MASCOTTE, FL 34753-9102
(352) 255-6458
(352) 410-6118
Mailing address
PO BOX 444, MASCOTTE, FL 34753-0444
(352) 255-6458
(352) 410-6118
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
IMH 11052
FL
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004444700
—
FL
05
—
004444701
—
FL
Enumeration date
08/22/2012
Last updated
07/30/2013
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