Provider Demographics
NPI:1851652853
Name:HARTZ, DAMITA AUTRECIA (AP, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:DAMITA
Middle Name:AUTRECIA
Last Name:HARTZ
Suffix:
Gender:F
Credentials:AP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 NW 43RD ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6677
Mailing Address - Country:US
Mailing Address - Phone:352-448-5836
Mailing Address - Fax:352-448-7789
Practice Address - Street 1:2610 NW 43RD ST STE 1B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6677
Practice Address - Country:US
Practice Address - Phone:352-448-5836
Practice Address - Fax:352-448-7789
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4015171100000X
FLMH17036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171100000XOther Service ProvidersAcupuncturist