Individual
ASHLEY MEDORA LE GRANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1801 SE HILLMOOR DR, PORT ST LUCIE, FL 34952-7553
(772) 204-2895
Mailing address
3793 SW PHEASANT RUN, PALM CITY, FL 34990-2581
(772) 263-3974
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH12264
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MH12664
LMHC
FL
Enumeration date
07/19/2017
Last updated
07/19/2017
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