Ivy Bridge Counseling, Inc.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

IVY BRIDGE COUNSELING, INC.

Practice address

587 E Sr 434 Unit 1021B
Longwood, FL 32750-5284

Phone

(407) 565-7942

Fax

(540) 566-5036

NPI assigned

Aug 15, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Renata Huewitt, LPCNPI 1609332402

Title

Owner, Mental Health Therapist

Phone

(912) 572-1602

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Renata Huewitt, LPC, LMHC

  • Professional Counselor
  • Longwood, FL
  • NPI 1609332402
  Medicare reassignment Care Compare group NPD Authorized official
• Madison K Housden, LCSW

  • Mental Health Counselor
  • Eustis, FL
  • NPI 1316751308
  Medicare reassignment Care Compare group NPD
• Haley Radliff

  • Mental Health Counselor
  • Longwood, FL
  • NPI 1447013529
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1497483689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2272 WEKIVA VILLAGE LN",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "327032511",
            "telephone_number": "912-572-1602",
            "fax_number": "540-566-5036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "587 E SR 434 UNIT 1021B",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505284",
            "telephone_number": "407-565-7942",
            "fax_number": "540-566-5036"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "839 Pinewood Dr NW",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "24017",
            "country_code": "US",
            "telephone_number": "540-632-0328",
            "fax_number": "540-566-5036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IVY BRIDGE COUNSELING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-15",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "HUEWITT",
        "authorized_official_first_name": "RENATA",
        "authorized_official_title_or_position": "OWNER, MENTAL HEALTH THERAPIST",
        "authorized_official_telephone_number": "912-572-1602",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30017481030001",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Muntaseer Islam, RBT
• Zunaira Islam, M.D.
• Island Lake Center, LLC (Island Lake Center)
• Rachel Elizabeth Israel, DOM, AP
• Nicole Christine Ivelevitch, LCSW, LSW, LMSW
• Iyer Sankaran M.D.P.a.
• Ashleigh Rose Jachles, RCSWI
• Lija Jacob, NP
• Shiney Alex Jacob, PHD, DNP, MSHI, MPH,
• Kiana Nancy Jaime

• Mental Health Counselor in Longwood, FL
• Providers in Longwood, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.