Most Relevant Information
Provider Data
| NPI Number: | 1003533423 |
| Provider Name: | ALTAGRACE K SOUVERAIN LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | SW20568 |
Most Important Dates
| Enumeration Date: | 10/26/2022 |
| Last Updated: | 10/26/2022 |
Provider Practice Location
2140 N DON WICKHAM DR
CLERMONT
FL
347111922
Practice Location Phone/Fax
| Phone: | 3523945922 |
| Fax: |
Provider Mailing Location
PO BOX 491000
LEESBURG
FL
347491000
Provider Mailing Phone/Fax
| Phone: | 3523157500 |
| Fax: |