Provider Demographics
NPI:1336910470
Name:SNELL, CHARNIQUA
Entity type:Individual
Prefix:
First Name:CHARNIQUA
Middle Name:
Last Name:SNELL
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 1:605 E ROBINSON ST STE 710
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2047
Mailing Address - Country:US
Mailing Address - Phone:407-801-9712
Mailing Address - Fax:
Practice Address - Street 1:605 E ROBINSON ST STE 710
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2047
Practice Address - Country:US
Practice Address - Phone:407-579-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health