Organization
CHANGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KWANYA SANDERS LMHC (EXECUTIVE DIRECTOR)
(321) 255-7991
Entity
Organization
Contact information
Practice address
3270 SUNTREE BLVD, SUITE 127, MELBOURNE, FL 32940-7530
(321) 255-7991
(321) 639-3207
Mailing address
3270 SUNTREE BLVD, SUITE 127, MELBOURNE, FL 32940-7530
(321) 255-7991
(321) 639-3207
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
FL
Other
Enumeration date
08/01/2007
Last updated
08/01/2007
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