Healthcare Provider Details

I. General information

NPI: 1023102779
Provider Name (Legal Business Name): STEVEN C VANGELDER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 MEMORIAL CIR
ORMOND BEACH FL
32174-5001
US

IV. Provider business mailing address

510 VONDERBURG DRIVE SUITE 301
BRANDON FL
33511-6072
US

V. Phone/Fax

Practice location:
  • Phone: 386-310-8766
  • Fax: 386-310-8770
Mailing address:
  • Phone: 813-881-1000
  • Fax: 813-689-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberCAP 3318
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: