Provider Demographics
NPI:1710922158
Name:STOCKSTILL, MARY ANN TERESA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:TERESA
Last Name:STOCKSTILL
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 1:2100 CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4146
Mailing Address - Country:US
Mailing Address - Phone:941-929-0715
Mailing Address - Fax:941-921-7105
Practice Address - Street 1:2100 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4146
Practice Address - Country:US
Practice Address - Phone:941-929-0715
Practice Address - Fax:941-921-7105
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health