Provider Demographics
NPI:1306131529
Name:CULBREATH, MORESA
Entity type:Individual
Prefix:
First Name:MORESA
Middle Name:
Last Name:CULBREATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 PARK CENTER DR STE 12
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5700
Mailing Address - Country:US
Mailing Address - Phone:321-320-8472
Mailing Address - Fax:
Practice Address - Street 1:1601 PARK CENTER DR STE 12
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5700
Practice Address - Country:US
Practice Address - Phone:321-320-8472
Practice Address - Fax:407-209-0329
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No171W00000XOther Service ProvidersContractor