Provider Demographics
NPI:1578737565
Name:DEACON, WILLIAM EDWARD (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:DEACON
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 MAIN ST
Mailing Address - Street 2:SUITE # 12
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5824
Mailing Address - Country:US
Mailing Address - Phone:941-377-7398
Mailing Address - Fax:
Practice Address - Street 1:1620 MAIN ST
Practice Address - Street 2:SUITE # 12
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5824
Practice Address - Country:US
Practice Address - Phone:941-377-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 740101YA0400X
FLMH2511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)