Healthcare Provider Details

I. General information

NPI: 1851640676
Provider Name (Legal Business Name): FAITH GISONDI MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SW SAINT LUCIE CRES STE 106
STUART FL
34994-2860
US

IV. Provider business mailing address

615 SW SAINT LUCIE CRES STE 106
STUART FL
34994-2860
US

V. Phone/Fax

Practice location:
  • Phone: 772-215-2181
  • Fax: 772-209-7054
Mailing address:
  • Phone: 772-215-2181
  • Fax: 772-209-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: