Provider Demographics
NPI:1922396522
Name:JAYNE-VANSICKLE, HEATHER (LMHC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:JAYNE-VANSICKLE
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 1:520 W LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-7424
Mailing Address - Country:US
Mailing Address - Phone:800-614-4124
Mailing Address - Fax:888-217-4124
Practice Address - Street 1:1260 ROCKLEDGE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2728
Practice Address - Country:US
Practice Address - Phone:800-614-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-16
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health