Provider Demographics
NPI:1609228170
Name:STALNAKER-CAUWENBERGHS, CECELIA A (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CECELIA
Middle Name:A
Last Name:STALNAKER-CAUWENBERGHS
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 1:3015 PARENTAL HOME RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5704
Mailing Address - Country:US
Mailing Address - Phone:904-710-0502
Mailing Address - Fax:
Practice Address - Street 1:3015 PARENTAL HOME RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5704
Practice Address - Country:US
Practice Address - Phone:904-710-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health