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1851749857
DEIDRA BASS
PORT SAINT LUCIE, FL
NPI
1851749857
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: FL 900341538)
Enumeration Date
2016-05-31
Last Update Date
2016-05-31
Business Address
-- DEIDRA BASS
525 NW LAKE WHITNEY PL
PORT SAINT LUCIE, FL 34986-1605
Phone number: 772-446-1148
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Mailing Address
-- DEIDRA BASS
525 NW LAKE WHITNEY PL
PORT SAINT LUCIE, FL 34986-1605
Phone number: 772-446-1148
Copy
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