Provider Demographics
NPI:1053982645
Name:PUPUHI, AVA CARLA
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:CARLA
Last Name:PUPUHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:CARLA
Other - Last Name:PUPUHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASTERS
Mailing Address - Street 1:567 NW LAKE WHITNEY PL STE 101
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:567 NW LAKE WHITNEY PL
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1629
Practice Address - Country:US
Practice Address - Phone:772-337-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health