Healthcare Provider Details

I. General information

NPI: 1295944148
Provider Name (Legal Business Name): NANCY AVALONE LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15120 COUNTY LINE RD
SPRING HILL FL
34610-6725
US

IV. Provider business mailing address

318 MAYES FARM TRL NW
MARIETTA GA
30064-5623
US

V. Phone/Fax

Practice location:
  • Phone: 727-480-7504
  • Fax:
Mailing address:
  • Phone: 727-480-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: