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ALTAGRACE LINDSAY GUSTAVE

Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1619642519

Individual Registrant:
 ALTAGRACE LINDSAY GUSTAVE 
Gender: F
Sole Proprietor

Location and contact information for practice:
2780 SW 37TH AVE STE 206  COCONUT GROVE, FL 33133-2740 US
Tel: 305-646-0112  Fax: --

Contact information for business:
1175 NE 147TH ST  NORTH MIAMI, FL 33161-2442 US
Tel: 786-277-7394  Fax: --

Registration Information:
NPI: 1619642519
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health
IMH18061

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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