Provider Demographics
NPI:1528591054
Name:VAZQUEZ, EDLIZ (LPC, LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:EDLIZ
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LPC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 LOUISIANA AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2350
Mailing Address - Country:US
Mailing Address - Phone:470-510-7479
Mailing Address - Fax:
Practice Address - Street 1:1133 LOUISIANA AVE STE 208
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2350
Practice Address - Country:US
Practice Address - Phone:470-510-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health