Provider Demographics
NPI:1326109307
Name:STEGALL, CONSTANCE A (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:A
Last Name:STEGALL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 SE 40TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7913
Mailing Address - Country:US
Mailing Address - Phone:239-549-8342
Mailing Address - Fax:239-772-4425
Practice Address - Street 1:1505 SE 40TH ST STE E
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7913
Practice Address - Country:US
Practice Address - Phone:239-549-8342
Practice Address - Fax:239-772-4425
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist