Provider Demographics
NPI:1578102828
Name:PRESTON, VELDA ELAINE
Entity Type:Individual
Prefix:
First Name:VELDA
Middle Name:ELAINE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 KENSINGTON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-3870
Mailing Address - Country:US
Mailing Address - Phone:813-804-0690
Mailing Address - Fax:
Practice Address - Street 1:736 KENSINGTON LAKE CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3870
Practice Address - Country:US
Practice Address - Phone:813-804-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1271104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker