Provider Demographics
NPI:1417257460
Name:ASBURY-STAPLE, VENATORIA ELLEN (LMHC)
Entity Type:Individual
Prefix:
First Name:VENATORIA
Middle Name:ELLEN
Last Name:ASBURY-STAPLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 COQUINA ST SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-4518
Mailing Address - Country:US
Mailing Address - Phone:321-704-7493
Mailing Address - Fax:
Practice Address - Street 1:907 COQUINA ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-4518
Practice Address - Country:US
Practice Address - Phone:321-704-7493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker