Provider Demographics
NPI:1508424292
Name:CONRAD, DEEDRA (LMHC)
Entity Type:Individual
Prefix:
First Name:DEEDRA
Middle Name:
Last Name:CONRAD
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 1:5500 SE 44TH CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-4920
Mailing Address - Country:US
Mailing Address - Phone:352-229-4851
Mailing Address - Fax:
Practice Address - Street 1:1701 NE 42ND AVE STE 301
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-8026
Practice Address - Country:US
Practice Address - Phone:352-290-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty