Provider Demographics
NPI:1316759947
Name:MORLA, MIA (MA-BEHAVIOR)
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:
Last Name:MORLA
Suffix:
Gender:F
Credentials:MA-BEHAVIOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 HOLBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6332
Mailing Address - Country:US
Mailing Address - Phone:786-506-0415
Mailing Address - Fax:
Practice Address - Street 1:580 HOLBROOK CIR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6332
Practice Address - Country:US
Practice Address - Phone:786-506-0415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty