Provider Demographics
NPI:1629047972
Name:DUMVILLE, ELIZABETH (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:DUMVILLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4729 US 98 S STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4323
Mailing Address - Country:US
Mailing Address - Phone:863-877-1855
Mailing Address - Fax:863-646-6111
Practice Address - Street 1:107 MORNINGSIDE DR STE C
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803
Practice Address - Country:US
Practice Address - Phone:863-606-6001
Practice Address - Fax:863-606-6002
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6514101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7728917OtherAETNA
FLZ9289OtherFLORIDA BLUE