Provider Demographics
NPI:1689270944
Name:GADDIS, VIRGINIA BAEZ (LMHC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:BAEZ
Last Name:GADDIS
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 1:8320 NW 7TH ST APT 97
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3938
Mailing Address - Country:US
Mailing Address - Phone:305-209-9788
Mailing Address - Fax:
Practice Address - Street 1:8320 NW 7TH ST APT 97
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3938
Practice Address - Country:US
Practice Address - Phone:305-209-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLMH18216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst