Provider Demographics
NPI:1114696804
Name:SAMMONS, STEPHANIE J (MA, RMHCI)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:SAMMONS
Suffix:
Gender:F
Credentials:MA, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9309 WINDRIFT CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34945-3303
Mailing Address - Country:US
Mailing Address - Phone:954-642-6224
Mailing Address - Fax:
Practice Address - Street 1:1680 SE LYNGATE DR STE 204
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-4300
Practice Address - Country:US
Practice Address - Phone:772-226-0383
Practice Address - Fax:772-237-5496
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20627101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty