Provider Demographics
NPI:1083957609
Name:ALLGOOD, CONNIE YVONNE (MA, LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:YVONNE
Last Name:ALLGOOD
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 US HIGHWAY 1
Mailing Address - Street 2:UNIT F
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958
Mailing Address - Country:US
Mailing Address - Phone:321-591-9516
Mailing Address - Fax:
Practice Address - Street 1:920 US HIGHWAY 1
Practice Address - Street 2:UNIT F
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958
Practice Address - Country:US
Practice Address - Phone:321-591-9516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104302200Medicaid