Provider Demographics
NPI:1568499432
Name:DESILVESTRO, PATRICIA ANN (LMHC NCC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:DESILVESTRO
Suffix:
Gender:F
Credentials:LMHC NCC
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:HALLAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4981 PLEASANT HOLLOW TRAIL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811
Mailing Address - Country:US
Mailing Address - Phone:863-644-5118
Mailing Address - Fax:863-644-5118
Practice Address - Street 1:2031 E EDGEWOOD DR
Practice Address - Street 2:QUEST COUNSELING CENTER SUITE #4
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3659
Practice Address - Country:US
Practice Address - Phone:863-655-8999
Practice Address - Fax:863-644-5118
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PIN5220325OtherAETNA INS