Provider Demographics
NPI:1437443546
Name:STEGALL, VIRGINIA TAYLOR (EDS, LMHC, AND LMFT)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:TAYLOR
Last Name:STEGALL
Suffix:
Gender:F
Credentials:EDS, LMHC, AND LMFT
Other - Prefix:MS
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:STEGALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDS, LMHC, AND LMFT
Mailing Address - Street 1:117 MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:FL
Mailing Address - Zip Code:32666-4128
Mailing Address - Country:US
Mailing Address - Phone:352-339-6791
Mailing Address - Fax:
Practice Address - Street 1:728 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3637
Practice Address - Country:US
Practice Address - Phone:352-487-0064
Practice Address - Fax:352-244-0464
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2547101YM0800X
FLMT 1432106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health