Provider Demographics
NPI:1619548708
Name:FERNANDEZ, YVONNE E (LMFTA)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:E
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FAWN HILL DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-8066
Mailing Address - Country:US
Mailing Address - Phone:626-437-6370
Mailing Address - Fax:
Practice Address - Street 1:945 E MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2119
Practice Address - Country:US
Practice Address - Phone:864-383-9002
Practice Address - Fax:864-383-9011
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health