Healthcare Provider Details

I. General information

NPI: 1669988606
Provider Name (Legal Business Name): SHAKIRA VASQUEZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 FAIRFAX ST
ORLANDO FL
32812-7732
US

IV. Provider business mailing address

5512 FAIRFAX ST
ORLANDO FL
32812-7732
US

V. Phone/Fax

Practice location:
  • Phone: 202-374-0573
  • Fax: 407-382-0659
Mailing address:
  • Phone: 202-374-0573
  • Fax: 407-382-0659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: