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General NPI Number Information
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NPI Number | 1043700586
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Entity Type | Individual
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Provider Name | LINDA L STANISLAW LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 1340 WRIGHT ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-1850
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Country | US
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Telephone | 407-616-9866
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Fax |
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Provider Business Mailing Address
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Address Line | 5300 S ATLANTIC AVE APT 17404
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-7524
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Country | US
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Telephone | 407-616-9866
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH11351
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License Number State | FL
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