Provider Demographics
NPI:1124581848
Name:MENDEZ-AGUDELO, LINA MARCELA (MS, NCC)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:MARCELA
Last Name:MENDEZ-AGUDELO
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:LINA
Other - Middle Name:MARCELA
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 BRIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-8805
Mailing Address - Country:US
Mailing Address - Phone:908-294-1754
Mailing Address - Fax:
Practice Address - Street 1:300 BRIDGEWATER DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-8805
Practice Address - Country:US
Practice Address - Phone:908-294-1754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist