Healthcare Provider Details

I. General information

NPI: 1043103732
Provider Name (Legal Business Name): CORDETTE F VANZANT LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 NE 48TH ST APT 6
POMPANO BEACH FL
33064-6515
US

IV. Provider business mailing address

4651 SALISBURY RD STE 400
JACKSONVILLE FL
32256-6187
US

V. Phone/Fax

Practice location:
  • Phone: 646-836-2567
  • Fax:
Mailing address:
  • Phone: 646-941-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: