Provider Demographics
NPI:1588834725
Name:STEPHENS, GLENDORIA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:GLENDORIA
Middle Name:
Last Name:STEPHENS
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 1:3875 TIGER BAY RD
Mailing Address - Street 2:RM 914 BLDG I
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124
Mailing Address - Country:US
Mailing Address - Phone:386-323-2202
Mailing Address - Fax:386-323-2274
Practice Address - Street 1:3875 TIGER BAY RD
Practice Address - Street 2:RM 914 BLDG I
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124
Practice Address - Country:US
Practice Address - Phone:386-947-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8403101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor