Healthcare Provider Details

I. General information

NPI: 1093475600
Provider Name (Legal Business Name): SAVANNA STEWART LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 CRYSTAL LAKE DR
LAKELAND FL
33801-5979
US

IV. Provider business mailing address

1815 CRYSTAL LAKE DR
LAKELAND FL
33801-5979
US

V. Phone/Fax

Practice location:
  • Phone: 863-709-9392
  • Fax:
Mailing address:
  • Phone: 863-709-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: