Provider Demographics
NPI:1861451585
Name:AYALA-ST.CHARLES, GLORIA (LMHC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:AYALA-ST.CHARLES
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 1:10701 NW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3668
Mailing Address - Country:US
Mailing Address - Phone:954-757-6882
Mailing Address - Fax:
Practice Address - Street 1:1515 N UNIVERSITY DR
Practice Address - Street 2:SUITE 116A
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6096
Practice Address - Country:US
Practice Address - Phone:954-234-8278
Practice Address - Fax:954-255-1755
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health