Provider Demographics
NPI:1821466350
Name:ST VIL, ISLAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ISLAINE
Middle Name:
Last Name:ST VIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 LITHIA PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5630
Mailing Address - Country:US
Mailing Address - Phone:813-495-6702
Mailing Address - Fax:813-425-5739
Practice Address - Street 1:3005 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5630
Practice Address - Country:US
Practice Address - Phone:813-495-6702
Practice Address - Fax:813-425-5739
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL131211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical