Provider Demographics
NPI:1821554981
Name:MOSAL, FONDA E (DMFT, LMHC, NCC)
Entity Type:Individual
Prefix:DR
First Name:FONDA
Middle Name:E
Last Name:MOSAL
Suffix:
Gender:F
Credentials:DMFT, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BARTRAM MARKET DR STE 135-169
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4581
Mailing Address - Country:US
Mailing Address - Phone:904-373-8516
Mailing Address - Fax:
Practice Address - Street 1:155 BARTRAM MARKET DR STE 135-169
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4581
Practice Address - Country:US
Practice Address - Phone:904-373-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health