Healthcare Provider Details

I. General information

NPI: 1437443546
Provider Name (Legal Business Name): VIRGINIA TAYLOR STEGALL EDS, LMHC, AND LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINGER STEGALL EDS, LMHC, AND LMFT

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 NE 7TH ST
TRENTON FL
32693-3637
US

IV. Provider business mailing address

117 MAGNOLIA CT
MELROSE FL
32666-4128
US

V. Phone/Fax

Practice location:
  • Phone: 352-487-0064
  • Fax: 352-244-0464
Mailing address:
  • Phone: 352-339-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 2547
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT 1432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: